Learning Curve in Surgical Treatment of Odontoid Fixation for a Series of Type II C2 Fractures

  • Rosario Maugeri
  • Domenico Gerardo Iacopino
  • Giuseppe Roberto Giammalva
  • Francesca Graziano
  • Carlo Gulì
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


The craniovertebral junction (CVJ) is a complex anatomical area upon which most of the motion of the upper cervical spine depends [1]. Because of its unique range of motion, the CVJ is subject to several types of traumatic injury; it has been shown that odontoid fractures are the most common ones in the general population and are the most common isolated spinal fractures [2]. Accounting for up to 18% of all cervical fractures, odontoid fractures are the most common ones in elderly patients [3], in whom they account for up to 60% of spinal cord injuries [4].


Type II odontoid fracture C1–C2 instability Odontoid screw C1–C2 articular screw Learning curve 


Competing Interests

The authors declare that they have no competing interests.

Compliance with Ethical Standards

No financial support was received for this work.


  1. 1.
    Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus. 2015;38(4):E2.CrossRefGoogle Scholar
  2. 2.
    Etter C. Combined anterior screw fixation of an odontoid fracture and the atlanto-axial joints (C1/C2) in a geriatric patient. Eur Spine J. 2016;25:280–4.CrossRefGoogle Scholar
  3. 3.
    Salem KMI, Collins I, Boszczyk BM. Salvage of failed odontoid fixation through anterior C1/C2 transarticular screws. Eur Spine J. 2015;24(3):609–14.CrossRefGoogle Scholar
  4. 4.
    Graffeo CS, Perry A, Puffer RC, Carlstrom LP, Chang W, Mallory GW, Clarke MJ. Deadly falls: operative versus nonoperative management of type II odontoid process fracture in octogenarians. J Neurosurg Spine. 2016;26(January):1–6.Google Scholar
  5. 5.
    Anderson LD, Alonzo RTD. Fractures of the odontoid process of the axis JBJS Classics Fractures of the Odontoid Process of the axis. J Bone Jt Surg Am. 1974;56(8)):1663–74.CrossRefGoogle Scholar
  6. 6.
    Pal D, Sell P, Grevitt M. Type II odontoid fractures in the elderly: an evidence-based narrative review of management. Eur Spine J. 2011;20(2):195–204.CrossRefGoogle Scholar
  7. 7.
    Visocchi M, Iacopino D, Signorelli F, Olivi A, Maugeri R. Walk the line. The surgical highways to the craniovertebral junction in endoscopic approaches: a historical perspective. World Neurosurg. 2018;110:544–57.CrossRefGoogle Scholar
  8. 8.
    Simmonst EH, Bhalla SK, Butt WP. Anterior cervical discectomy and fusion. J Bone Jt Surg. 1969;51(B2):225–37.CrossRefGoogle Scholar
  9. 9.
    Harel R, Pfeffer R, Levin D, Shekel E, Epstein D, Tsvang L, Ben Ayun M, Alezra D, Zach L. Spine radiosurgery: lessons learned from the first 100 treatment sessions. Neurosurg Focus. 2017;42(1):1–6.Google Scholar
  10. 10.
    Graziano F, Maugeri R, Basile L, Meccio F, Iacopino D. Aulogous fibrin sealant (Vivostat®) in the neurosurgical practice: part II: vertebro-spinal procedures. Surg Neurol Int. 2016;7(4):77.CrossRefGoogle Scholar
  11. 11.
    Iacopino D, Certo F, Basile L, Graziano F, Maugeri R, Grasso G, Meccio F, Ganau M. Autologous fibrin sealant (Vivostat®) in the neurosurgical practice: part I: intracranial surgical procedure. Surg Neurol Int. 2015;6(1):77.CrossRefGoogle Scholar
  12. 12.
    Maugeri R, Giammalva G, Graziano F, Iacopino DG. May autologue fibrin glue alone enhance ossification? An unexpected spinal fusion. World Neurosurg. 2016;95:611–2.CrossRefGoogle Scholar
  13. 13.
    Shen Y, Miao J, Li C, Fang L, Cao S. A meta-analysis of the fusion rate from surgical treatment for odontoid factures: anterior odontoid screw versus posterior C1–C2 arthrodesis. Eur Spine J. 2015;24(8):1649–57.CrossRefGoogle Scholar
  14. 14.
    Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Ton L, Rogers MA, Wilde PH. The learning curve of pedicle screw placement: how many screws are enough? Spine (Phila Pa 1976). 2009;34(21):E761–5.CrossRefGoogle Scholar
  15. 15.
    Lee J, Jang H, Shin B. Learning curve and clinical outcomes of minimally invasive transforaminal lumbar interbody fusion: our experience in 86 consecutive cases. Spine (Phila Pa 1976). 2012;37(18):1548–57.CrossRefGoogle Scholar
  16. 16.
    Shou X, Shen M, Zhang Q, Zhang Y, He W, Ma Z, Zhao Y, Li S, Wang Y. Endoscopic endonasal pituitary adenomas surgery: the surgical experience of 178 consecutive patients and learning curve of two neurosurgeons. BMC Neurol. 2016;16(1):247.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Rosario Maugeri
    • 1
  • Domenico Gerardo Iacopino
    • 1
  • Giuseppe Roberto Giammalva
  • Francesca Graziano
  • Carlo Gulì
  1. 1.Neurosurgical Clinic, AOUP “Paolo Giaccone”, PostGraduate Residency Program in Neurologic Surgery, Department of Experimental Biomedicine and Clinical Neurosciences, School of MedicineUniversity of PalermoPalermoItaly

Personalised recommendations