Journal de la colonne vertébrale

Anterior Screw Fixation for Odontoid Fracture Using the Direct Approach at the C2-C3 Level: Case Report and Literature Review

Abstract

Wuilker Knoner Campos and Daniel dos Santos Sousa

Fractures of the odontoid process comprise 10–15% of all cervical fractures. Almost two thirds of all dens fractures are classified as type II according to Anderson and D’Alonso classification system. Currently, the direct anterior odontoid screw fixation provides the best anatomical and functional results for this type of fracture and it is considered as the treatment of choice. Regarding the approach to the C2 vertebra, about 80% of authors usually make a skin incision at the lower cervical level (C4-C5 or C5-C6) for creating a working corridor. However, the required exposure and the relatively blind passage of the screw can damage the surrounding soft tissue. The direct approach at the C2- C3 level could be a shorter and safer working corridor to the odontoid screw fixation with less soft tissue retraction. Here we present a case report of a 62-year-old man who presented with Type II odontoid fracture and subsequently underwent a direct anterior odontoid screw fixation through a mini-open approach at the C2-C3 level. The literature available in the English language on related-approach complications of anterior odontoid screw fixation is reviewed.