A NEW MINIMALLY INVASIVE METHOD FOR FIXATION OF UNSTABLE ODONTOID FRACTURES: INITIAL CLINICAL RESULTS AND TECHNICAL FEATURES.
Keywords:
C2 odontoid fracture, minimally invasive fixation, anterior screw fixation, single-screw fixation, atlantoaxial joint.Abstract
The aim of the study was to evaluate the safety and effectiveness of minimally invasive percutaneous anterior single-screw fixation of the odontoid process in unstable C2 fractures. Data from 18 patients (14 men, 4 women) treated from September 2023 to April 2025 were analyzed. The procedure was performed under fluoroscopic guidance using a specialized 14-cm stainless steel needle (outer diameter 3.0 mm, inner channel 2.0 mm) as a sleeve for inserting a guide wire with a fine-threaded tip and a 6-mm dilator (access 3–4 mm). All procedures were completed successfully without complications. At 6 months follow-up, 16 patients (88.9%) achieved complete fracture union. Pain and neck mobility limitations were minimal. The method provides reliable stabilization, preserves atlantoaxial mobility, and enables accelerated rehabilitation.
References
Aebi M, Etter C, Coscia M. Fractures of the odontoid process. Treatment with anterior screw fixation. Spine (Phila Pa 1976) 1989;14: 1065-70.
Agrillo U, Mastronardi L, Puzzilli F. Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery 2000;47:794.
Bohler J. Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am 1982;64:18-27.
Boorm W, Kast E, Richter HP, Mohr K. Anterior screw fixation in type II odontoid fractures: is there a difference in outcome between age groups? Neurosurgery 2003;52:1089-92; discussion 1092-4.
Borne GM, Bedou GL, Pinaudeau M, Cristino G, Hussein A. Odontoid process fracture osteosynthesis with a direct screw fixation technique in nine consecutive cases. J Neurosurg 1988;68:223-6.
Chi YL, Wang XY, Xu HZ, et al. Management of odontoid fractures with percutaneous anterior odontoid screw fixation. Eur Spine J 2007; 16:1157-64. DOI 10.1007/s00586-007-0331-0.
Clark CR, White AA. Dens fracture: a multicenter study. J Bone Joint Surg Am 1985;67:1340-8.
Denaro V, Papalia R, Di Martino A, Denaro L, Maffulli N. The best surgical treatment for type II fractures of the dens is still controversial. Clin Orthop Relat Res 2011;469:742-50. doi: 10.1007/s11999-010-1677-x.
Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine 2000;26:2467-71.
Henry AD, Bohly J, Grosse A. Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg [Br] 1999;81-B:472-7.
Kuziev O.I., Yuldashev R. M. The role of anterior single-screw fixation in the treatment of odontoid fracture. The bulletin of emergency medicine. 2022; 15:1; 32-37. doi: 10.54185/TBEM/vol15_iss1/a5.
Nakanishi T. Internal fixation of the odontoid fracture. Cent Jpn J Orthop Traumatic Surg 1980;23:399-406.
Park JH, Kang DH, Lee MK, et al. Advantages of direct insertion of a straight probe without a guide tube during anterior odontoid screw fixation of odontoid fractures. Spine (Phila Pa 1976) 2016; 41:E541-7. doi: 10.1097/BRS.0000000000001311.
Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955;96:223-4.
Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Jt. Surg 1958;40-A:607-24.
Wu AM, Wang XY, Xia DD, Luo P, Xu HZ, Chi YL. A novel technique of two-hole guide tube for percutaneous anterior odontoid screw fixation. Spine J 2015;15:1141-5. doi: 10.1016/j.spinee.2015.02.013
