Odontoid fracture type II Surgery

• Comparison of Mechanical Stress on Implants in Anterior Single and Double Screw Fixation of Odontoid Fractures in a Finite Element Model
• Masseter Sarcopenia and Mortality After Type II Odontoid Fractures in the Elderly: A 5-Year Follow-Up Study
• Comparative Effectiveness of Conservative Management Versus Surgical Fixation in Acute Type II Odontoid Fractures
• Traumatic posterior atlantoaxial dislocation based on imaging of the anterior arch-odontoid process-transverse ligament complex: a retrospective cohort study
• Hounsfield unit measurements to predict odontoid fracture union in elderly patients: post-hoc subgroup analysis from an international prospective comparative study
• Traumatic odontoid fracture - Proposal of a treatment algorithm
• The AO Spine Upper Cervical Injury Classification System (AO UCIC) - An Umbrella Review of Traumatic Axis Injuries Factors that May Affect Treatment Decision
• Safety of non-osseous union of type II odontoid fractures-a multi-institutional cohort study

• Assessing the Impact of Undiagnosed C1-C2 Rotatory Subluxation in the Conservative Treatment of Odontoid Fractures
• Clinical Outcomes Following Operative and Nonoperative Management of Odontoid Fractures Among Elderly Individuals with Dementia
• Case report: Interdisciplinary treatment of complex C1/C2 fractures in a patient with concomitant three-vessel coronary artery disease requiring bypass surgery
• O-Arm Assisted Anterior Odontoid Screw Fixation in Type II and Rostral Type III Odontoid Fractures: Single Center Surgical Series of 50 Patients
• An experience with Goel-Harms C1-C2 fixation for type II odontoid fractures
• Type II Odontoid Fractures Case Series: History of Seizures a Risk Factor for Failure of Non-operative Treatment of Type II Odontoid Fractures
• Percutaneous, Navigated Minimally Invasive Posterior Cervical Pedicle Screw Fixation
• Hangman's Fracture

Surgical treatment (instead of external immobilization) is recommended for odontoid Type II fractures in patients ≥7 years age with any of the following:

1. displacement ≥ 5mm

2. instability at the fracture site in the halo vest

3. age ≥50 years: increases nonunion rate (with halo) 21-fold

4. nonunion including firm fibrous union, especially if accompanied by myelopathy

5. disruption of the transverse ligament: associated with delayed instability

Common surgical option is an anterior odontoid screw. Some of the fractures are not suitable for anterior odontoid screw (anterior oblique, displaced distal fragments and those with atlantoaxial instability…).

These are usually offered posterior transarticular screws (Magerl's) or posterior atlantoaxial screw rod/plate fixation (Goel-Harms technique). Posterior surgery involves atlantoaxial fixation with an indirect attempt to reduce and fuse the fracture.

In cases of Chronic Type II odontoid fractures and in patients with transverse ligament disruption, Shilpakar et al. prefer to undertake posterior transarticular facet screw fixation supplemented by bone graft and interspinous C1-2 wiring ¹⁾.

No significant differences were found between bending and torsional stiffnesses for the one-screw and two-screw specimens. No significant differences were found between one- and two-screw fixation when compared with primary C1-C2 wiring in torsion. One- or two-screw fixation was as stiff as primary C1-C2 wiring in bending. One or two screws offers similar stability for fixation for a dens fracture. One- and two-screw fixation is at least as stiff as primary C1-C2 wiring in torsion and one- or two-screw fixation is stiffer than primary C1-C2 wiring in bending ²⁾.

see Anterior odontoid screw fixation.

see Anterior retropharyngeal plate screw fixation with bilateral anterior transarticular screws.

Commonly used procedures involve wedging a bone graft between posterior arch of C1 and the C2 lamina with sublaminar wiring. The well-described different methods for this C1- 2 posterior fusion procedure are the Gallie, Brooks, Sonntag techniques. These procedures have a satisfactory fusion rate of about 74 percent. The demerit of this procedure is that it causes elimination of the normal C1-2 rotatory motion ( which accounts for more than 50% of all cervical spine rotatory movements) and reduced cervical spine flexion– extension by 10 percent.

Another excellent alternative technique for odontoid fracture is the posterior C1-2 transarticular screw fixation (Magerl’s procedure) using unilateral or bilateral screws. This provides an excellent spinal rotational spinal stability. This is an indirect method of stabilizing the fracture (in which the normal anatomical configuration is disrupted). Preoperative CT evaluation is mandatory to avoid vertebral artery injury in this procedure. This technique can be supplemented with metal plate for occipito-cervical stabilization. Alternatively, Jain’s technique of occipitocervical fusion, Goel’s plate and screw lateral mass fixation, or a Ransford’s contoured rod technique31 may be utilized.

Posterior surgery has a risk of injury to the vertebral arteries, hemorrhage from the paravertebral venous plexus and the C2 root ganglion.