Anterior Odontoid Screw Fixation for Trauma: Case Series and Technical Considerations

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Spinal Surgery

Background:

• Odontoid fractures, particularly Anderson-D'Alonzo type II, present biomechanical instability and non-union risks.
• Posterior C1-C2 fusion offers high fusion rates but compromises atlantoaxial rotation.
• Anterior odontoid screw fixation (AOSF) allows direct osteosynthesis while preserving spinal motion.

Purpose of the Study:

• Evaluate radiographic outcomes, fusion rates, and technical aspects of AOSF for acute type II odontoid fractures.
• Identify anatomical and procedural factors influencing bone healing after AOSF.
• Assess the safety and efficacy of AOSF as a motion-preserving technique.

Main Methods:

• Retrospective, single-center case series of patients with acute type II odontoid fractures treated with AOSF (2018-2024).
• Inclusion criteria: CT-confirmed, reducible fractures.
• Radiographic parameters (fracture gap, angulation) measured on sagittal CT reconstructions; outcomes assessed at 6 weeks, 3, and 6 months; mean follow-up 24 months.

Main Results:

• Significant reduction in mean fracture gap (5.3 mm to 0.8 mm) and angulation (27.8° to 3.5°) (p < 0.0001).
• Achieved solid fusion in 90% of patients (9 out of 10); one patient required secondary posterior fixation.
• No intraoperative or postoperative complications, including infections, neurovascular injuries, or neurological deficits.

Conclusions:

• AOSF is a safe and effective motion-preserving treatment for selected Grauer IIA/IIB odontoid fractures.
• Precise anatomical reduction (gap < 2 mm, angulation < 5-10°) is a critical predictor of successful fusion.
• Further multicenter studies are needed to validate radiographic thresholds and optimize patient selection for AOSF.