Atlantoaxial arthrodesis to treat odontoid fractures

The authors reviewed 132 cases of cervical spine fracture over a 10-year period and found 24 cases of fracture of the odontoid process. Using the classification of Anderson and D'Alonzo, they found 20 patients with type II fractures and 4 with type III injuries. Sixteen patients with type II fractures and 1 with type III underwent posterior atlantoaxial fusion by the Gallie method or a modification of it. Immobilization following arthrodesis was by soft cervical ruffs and a four-poster collar. Solid fusion was obtained within 3 to 6 months in 15 of the 16 type II fractures; one patient was lost to follow-up. The one patient with a type III fracture obtained a solid fusion within 3 months. One patient had the fusion revised at 1 month for progressive displacement; otherwise there were no notable complications. It is almost impossible to determine whether the fracture fragments had united but this is not important as long as there is a solid fusion. Whether treatment of acute odontoid fractures, particularly type II, should be operative or nonoperative is controversial, but from this review the authors believe that primary treatment of type II odontoid fractures by posterior atlantoaxial arthrodesis with its low morbidity and high fusion rate is superior to nonoperative treatment.