Odontoid fractures anterior screw fixation: a continuous series of 36 cases.

Introduction: Fracture of the odontoid process represents 5 to 15% of cervical spine fractures. Anterior screw fixation is the reference technique in unstable posterior oblique or horizontal odontoid fracture.

Objective: We describe results with an original anterior screw fixation technique using a curved thoraco-lumbar pedicle awl to facilitate intra-operative reduction.

Patients And Methods: This is a retrospective study of 36 consecutive patients who underwent anterior screw fixation for odontoid process fracture. Mean age was 70.3 years. Twenty six patients had type II and 10 type III fracture on the Anderson-D'Alonzo classification. On the Roy-Camille classification, there were 34 posterior oblique fractures and two horizontal fractures. There were no anterior oblique fractures. Bony union was assessed on CT-scan at 3 months. We describe the surgical technique, which used a 4.5mm cannulated cancellous lag screw in all cases.

Results: Mean follow-up was 3 years (range, 4 months to 8 years). No intra-operative complications were observed. Union rate was 95% and the average time to union was 5 months (3 to 6 months).

Discussion: Anterior screw fixation is a common surgical treatment for posterior oblique and horizontal odontoid process fractures. We detail a reliable and reproducible intra-operative reduction maneuver to obtain a good union rate without complications.

Level Of Evidence: Level IV. Retrospective therapeutic study.