C1–C2 Pedicle Screw Fixation for Treatment of Old Odontoid Fractures

Abstract

Nonunion and C1-C2 instability of odontoid fractures usually result from delayed diagnosis and inappropriate treatment. However, the available treatment options for odontoid fractures remain controversial. The authors evaluated the effectiveness of internal screw fixation via the C1 and C2 pedicle in cases of old odontoid fractures. This retrospective study included 21 patients with old odontoid fractures (13 men and 8 women; mean age, 46.5 years; range, 24-69 years). Internal screw fixation via the C1 and C2 pedicle was performed in all patients. Fracture reduction and C1-C2 fusion were assessed with imaging. The neck pain visual analog scale score and cervical spinal cord functional Japanese Orthopaedic Association score (for those who had cervical spinal cord injury) were used to evaluate the effectiveness of treatment. Postoperative complications were recorded. Postoperative imaging showed that the C1-C2 dislocation was satisfactorily repositioned in all patients. Bone fusion was observed 1 year after surgery in all patients. No loosening or breaking of internal fixation occurred. The preoperative neck pain visual analog scale score was 5.9±1.5 and improved significantly to 1.8±0.8 after surgery (P<.001). The Japanese Orthopaedic Association score in patients with cervical spinal injury (n=14) was 9.2±1.9 and also significantly improved to 13.8±1.9 at the last follow-up examination (P<.001), with an average improvement rate of 61.0%. No iatrogenic vertebral artery injury or severe spinal cord injury occurred. Screw fixation via the C1 and C2 pedicle was found to be an effective and safe surgical approach for the treatment of old odontoid fractures with C1-C2 dislocation or instability.

Traumatic Atlantoaxial Lateral Subluxation With Chronic Type II Odontoid Fracture: A Case Report

“…Both type II and type III odontoid fractures have been associated with C1-C2 dislocations along the antero-posterior axis. 9 Our case of acute lateral atlantoaxial subluxation with chronic type II odontoid fracture has not been previously reported in the literature.…”

“…We identified several case reports and case series describing the occurrence and management of combined C1-C2 dislocation and fracture of the dens. 4,9,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] Corner described 2 of the earliest cases of rotatory dislocation of C1 relative to C2 with accompanying fractures of the odontoid process. 25…”

“…Posterior pedicle screw fixation of C1-C2 with bone graft fusion has been recommended as a safe and effective surgical treatment of atlantoaxial dislocation associated with old odontoid fracture. 9 We performed C1-C2 fusion with instrumentation with careful reduction of the dens in both planes under C-arm control. Postoperative x-rays indicated improved atlantoaxial alignment and reduction of the subluxation, which included improvement in the alignment of the odontoid fracture.…”

“…[11][12][15][16][17][18][19][22][23][24] However, C1-C2 subluxation has also been identified in patients with old odontoid fractures. 9,13,20,21 Fuentes et al 13 reported a case of posterior subluxation associated with an old type II odontoid fracture. Li et al 21 described a patient with dorsal subluxation and a chronic type II dens fracture.…”

“…8 Posterior instrumented fusion has been reported to effectively correct these injuries and lead to dissolution of pannus tissue. [9][10] The injury was treated by initial stabilization with hard collar, followed by posterior fusion with pedicle screws, pars screws, and locking rods.…”