Anterior C1-C2 screw fixation and bony fusion through an anterior retropharyngeal approach

We present a case that demonstrates an occasion where an alternative method of C1-C2 fusion may be used when a posterior approach limited to the atlantoaxial level is not desirable. A 22-year-old man presented with a symptomatic nonunited Brooks posterior atlantoaxial fusion following a chronically displaced type II odontoid fracture with a two-part fracture of the posterior arch of C1. An anterior retropharyngeal approach was used to perform an anterior C1-C2 fusion with screw fixation. The surgical technique, as well as the merits and indications of this infrequently used procedure, are discussed.