Anterior single lag screw fixation in Type II Dens fracture – Indian experience

Abstract

Increased rate of non-union of Type II Odontoid fractures with rigid external orthosis have been reported. Recently technique of direct anterior screw fixation of the odontoid fracture is being advocated. Here we report the results of 13 cases of Type II dens fracture treated by the above method with an age group ranging from 17 to 73 years. An approach identical to the anterior cervical discectomy was used. Guide tube system devised by Synthes®, single image intensifier and Langenberg retractors was used to place a single cannulated screw through the fracture from C2 body into the dens. Among the 13 cases operated, in 11 cases we were successful. In one case while dissecting the fracture site CSF leak occurred and in another case the guide wire broke leading to abandoning to screw placement. There was no other complication due to the surgical procedure. The follow up period ranged between 2 months to 3 1/2 years. There were no neurological complications or screw fracture. In 9 of the 11 cases (82%) either bony union or fibrous unions have occurred. These results indicate that direct anterior single screw fixation has proved to be a very successful treatment.

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

“…The neck incision was smaller than that in the traditional procedure because the exposure did not need to accommodate a three-or four-blade retractor system, only a specular retractor. Our cosmetic result was comparable to authors that used the anterior screw fixation through the endoscopically assisted system [40]. Regarding the percutaneous anterior odontoid screw fixation [26], a better cosmetic result is achieved.…”

Pooled Analysis of Non-Union, Re-Operation, Infection, and Approach Related Complications after Anterior Odontoid Screw Fixation

“…Surgical site infection was assessed in 20 studies [15] , [19] , [21] , [22] , [24] , [31] , [33] , [34] , [41] , [45] , [47] , [49] , [50] , [60] – [62] , [66] , [67] , [69] , [70] with 563 surgeries. The reported infection rate was low, with estimates varied from 0% to 6%.…”

Surgical management of odontoid fractures at Level one trauma center: A single-center series of 142 cases

“…Bhanot et al [39] reported a 94% fusion rate with one case of non-union and one screw pull-out in their series of 17 type II odontoid fractures after an anterior screw fixation. Shrinivasan et al [40] could successfully place OS in 84.6% type II fractures with an 82% fusion rate. Aldrian et al (2011) [35] showed a good fusion rate of 87% after OS fixation in type IIA fracture and have also recommended it as the first line of management in comminuted odontoid fractures.…”