Management of acute odontoid fractures with single-screw anterior fixation

OBJECTIVE: Accepted management strategies for odontoid fractures include ex ternal immobilization and surgical stabilization using anterior or posterio r approaches. Displaced Type II fractures and rostral Type III fractures ar e at high risk for nonunion. Anterior fixation of odontoid fractures with a single cortical rag screw is a relatively new technique that combines rigi d internal stabilization with preservation of intrinsic C1-C2 motion. We re trospectively reviewed our series of 26 consecutive patients who underwent odontoid screw fixation, to further define the safety and efficacy of the t echnique. METHODS: During a 5-year period, 26 patients presented with acute traumatic Type II odontoid fractures. Ten patients were female and 16 were male, wit h a mean age of 35 years. All patients underwent anterior odontoid screw fi xation by the senior surgeon (RWH), within a mean of 3 days after injury. A ll patients were postoperatively maintained in external orthoses, for a mea n of 7.2 weeks, and were monitored with serial clinical and radiographic ex aminations. RESULTS: With a mean follow-up period of 30 months, radiographic fusion was documented for 25 of 26 patients (96%). No complications related to the su rgical approach were identified, and all patients remained in neurologicall y stable condition. Two complications (8%) were related to the instrumentat ion; one patient required external immobilization because of suboptimal scr ew placement, and one patient required posterior atlantoaxial arthrodesis b ecause of inadequate fracture reduction. CONCLUSION: Single-screw anterior odontoid fixation was associated with a r elatively low complication rate and a high fusion rate in this study. We th ink that this should be the preferred treatment method for acute Type II od ontoid fractures.