Is It Feasible to Treat Odontoid Fractures via Primary Posterior Reduction and Fixation without Fusion?

Objective: To evaluate results and feasibility of primary posterior reduction and fixation without fusion using C1-C2 screw-rod system for odontoid fractures.

Methods: This study comprised a consecutive series of 46 patients with odontoid fractures. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed, and instrumentation was not removed. Radiologic outcomes were assessed on follow-up computed tomography or plain radiographs. Visual analog scale of neck pain, American Spinal Injury Association impairment scale, patient satisfaction, neck disability index, and range of motion of flexion extension and rotation of the cervical spine were recorded and analyzed.

Results: Mean follow-up time was 4.1 years (range, 12 months to 8 years). Radiographic evaluation indicated solid fusion of odontoid fractures in all cases and no implant failures. No patient reported severe neck pain at follow-up. Neurologicl evaluation showed there was 1- to 2-grade improvement in patients with neurologic deficit. Of patients, 31 reported acceptable outcomes, and 15 reported good outcomes. Range of motion of rotation of the cervical spine and neck disability index score gradually improved significantly during 1 year of follow-up with no obvious change after that. Rate of neck disability index score improvement was 85%.

Conclusions: Posterior reduction and fixation without fusion can be successfully performed for healing of odontoid fractures with acceptable results and minimal morbidity.