Odontoid Fracture: Anterior Screw Fixation

Abstract

Anterior screw fixation (ASF) in selected odontoid fractures is a very effective and well-accepted treatment option. Although the surgical approach and the fracture fixation itself are easy, there are a number of possible pitfalls any surgeon has to know about.

The ideal indication for ASF is type II fracture according to the classification of Anderson/D’Alonzo. Patient habitus has to be taken in consideration as the accessibility to the upper cervical spine might be limited. Careful closed reduction under image intensifier control is mandatory. Most of the authors recommend one or two 3.5–4 mm cannulated screws.

After surgery, an external brace for at least 6 weeks is recommended. Radiological follow-up after surgery, 6 and 12 weeks, is necessary. In case of a non-union with clinical deterioration, an additional posterior atlantal-axial fixation and fusion is an option.