Management of Acute Odontoid Fracture
In this article the authors describe the management of Type II odontoid fractures with special attention to operative technique and avoidance of complication. Anterior odontoid screw fixation is a procedure the authors have performed over the last 8 years in cases with acute Type II and rostral Type III odontoid fractures. In cases of Chronic Type II odontoid fractures and in patients with transverse ligament disruption, the authors prefer to undertake posterior transarticular facet screw fixation supplemented by bone graft and interspinous C1-2 wiring.
The technical aspects of these procedures are described with a focus on operative nuances. Selection criteria and techniques that the authors have refined over the years have helped them to optimize success rates and minimize complications.
The management of Type II odontoid fractures has evolved dramatically over the last 15 years. Earlier therapies in which rigid external cervical immobilization was used have given way to newer, more direct approaches of addressing the stabilization of fractures. Although earlier in the 1990s mixed results were reported regarding the efficacy of both anterior and posterior approaches to stabilization of this type of fracture, the authors of more recent studies have demonstrated that Type II fractures are best treated via an anterior approach, although some exceptions exist. These exceptions include chronic fractures and disruption of the transverse ligament, and in these cases a posterior approach is required.
In this report we describe the selection criteria, indications and contraindications, and technical nuances of managing patients with Type II odontoid fractures. We review our 8-year experience with the techniques of anterior odontoid screw fixation and C1-2 transarticular screw fixation.
Abstract and Introduction
Abstract
In this article the authors describe the management of Type II odontoid fractures with special attention to operative technique and avoidance of complication. Anterior odontoid screw fixation is a procedure the authors have performed over the last 8 years in cases with acute Type II and rostral Type III odontoid fractures. In cases of Chronic Type II odontoid fractures and in patients with transverse ligament disruption, the authors prefer to undertake posterior transarticular facet screw fixation supplemented by bone graft and interspinous C1-2 wiring.
The technical aspects of these procedures are described with a focus on operative nuances. Selection criteria and techniques that the authors have refined over the years have helped them to optimize success rates and minimize complications.
Introduction
The management of Type II odontoid fractures has evolved dramatically over the last 15 years. Earlier therapies in which rigid external cervical immobilization was used have given way to newer, more direct approaches of addressing the stabilization of fractures. Although earlier in the 1990s mixed results were reported regarding the efficacy of both anterior and posterior approaches to stabilization of this type of fracture, the authors of more recent studies have demonstrated that Type II fractures are best treated via an anterior approach, although some exceptions exist. These exceptions include chronic fractures and disruption of the transverse ligament, and in these cases a posterior approach is required.
In this report we describe the selection criteria, indications and contraindications, and technical nuances of managing patients with Type II odontoid fractures. We review our 8-year experience with the techniques of anterior odontoid screw fixation and C1-2 transarticular screw fixation.