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Low-cost Posterior C1-C2 Fusion Using Sublaminar Wiring in Neurologically Intact Young Patient with Type IIA Odontoid
Carlos Novondo1,2, César Alas-Pineda3, Anahi Gisselle Pacheco4
1Neurocirugía, Hospital Dr. Mario Catarino Rivas, San Pedro Sula, Cortés, Honduras.
Purpose:
To present a low-cost posterior cervical fixation technique using sublaminar wiring for the management of a comminuted odontoid fracture (type IIA) in a young, neurologically intact patient, emphasizing its relevance in low-resource environments where advanced instrumentation is inaccessible.
Methods:
A 21-year-old male sustained a comminuted fracture of the odontoid process of C2 following a high-impact motorcycle accident. Upon admission, he was alert, fully oriented, and neurologically intact. Imaging revealed a comminuted type IIA odontoid fracture without displacement. Due to the patient's economic limitations and the unsuitability of the fracture for anterior fixation, a posterior approach using double sublaminar wiring between C1 and C2 with autologous iliac crest bone graft was performed.
Results:
The procedure was successfully completed with no intraoperative or postoperative complications. The patient was discharged on postoperative day 2 and demonstrated excellent recovery. Follow-up imaging at 3 months confirmed over 90% fracture consolidation. Imaging at 6 months was requested but not obtained due to loss of follow-up. Functional recovery was complete, with only a partial reduction in cervical range of motion as expected with C1-C2 fusion.
Conclusion:
Sublaminar wiring offers a safe, effective, and affordable alternative for posterior fixation of comminuted odontoid fractures, particularly in young patients and in settings where access to advanced spinal instrumentation is limited.
