Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl–Gallie technique

  • Mootaz ShoushaEmail author
  • Mohamed Alhashash
  • Hassan Allouch
  • Heinrich Boehm
Original Article



This single-centre retrospective study compared anterior odontoid screw fixation and posterior atlantoaxial fusion in the surgical treatment of type II B odontoid fractures according to Grauer in elderly patients.


Between 1994 and 2014, 133 consecutive patients above 60 years presenting with type II B odontoid fracture were treated surgically in our department. They were divided retrospectively into two groups. Group A included 47 patients in whom anterior odontoid screw fixation was performed. Group B with 86 patients underwent posterior atlantoaxial fusion. The clinical and radiological data were analysed. Any reoperation during the follow-up was recorded and evaluated.


The mean age in group A (74.19 years) was significantly less than in group B (78.16 years). The mean operative time in group A (64.5 min) was significantly shorter than in group B (116 min). Again, the mean amount of blood loss in group A (79 ml) was significantly less than in group B (379 ml). The mean postoperative hospital stay was significantly shorter in group A (17.4 days) than in group B (30 days). The mean follow-up was 29.3 months in group A and 32 months in group B. The rate of pseudoarthrosis was significantly higher in group A (25.5%) than in group B (3.5%). Furthermore, the need for revision surgery was significantly increased in group A (23.4%) than in group B (10.47%).


Odontoid screw fixation is a less invasive surgery for type II B odontoid fractures in elderly patients. However, posterior atlantoaxial fusion provides a superior surgical outcome regarding fracture healing and the need for surgical revisions.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Retrospective study Odontoid fracture in elderly Odontoid screw Atlantoaxial fusion 


Compliance with ethical standards

Conflict of interest


Supplementary material

586_2019_5946_MOESM1_ESM.pptx (522 kb)
Supplementary material 1 (PPTX 522 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Spine SurgeryZentralklinik Bad BerkaBad BerkaGermany
  2. 2.Department of Orthopedic SurgeryAlexandria UniversityAlexandriaEgypt

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