[Ventral direct screw fixation in dens fractures]

Direct anterior screw fixation of odontoid fractures is indicated in type II and occasionally type III fractures according to the Anderson and d'Alonzo classification. This fracture treatment follows the generally accepted concepts of surgical treatment of limb fractures. It is direct osteosynthesis of a fracture by screw fixation with interfragmentary compression and differs fundamentally from all other treatment methods in spinal fractures, where the treatment is combined with fusion and definite immobilization of a motion segment. The iatrogenic trauma is minimal by using an anterior surgical approach and no supplemental bone grafting is required. The postoperative care is very simple, and the fusionless fracture fixation has a better functional outcome. With the introduction of cannulated screws, which can be inserted over K-wires, the surgical procedure has been further simplified and minimizes the peroperative risks. After initial complications in the first series of 17 patients, the most recent 15 cases were without complications. This stresses the fact that this surgical procedure should only be done by spine surgeons who are familiar with the upper cervical spine and osteosynthesis techniques.