Anterior Screw Fixation for a Pediatric Odontoid Nonunion

Abstract

A case of an odontoid nonunion in a child treated with anterior screw fixation. To demonstrate that an anterior screw procedure can be performed with an odontoid nonunion with resultant fusion to maintain range of motion. A 15-year-old boy presented with pain in his neck following a rugby football injury. Admission plain radiographs and computed tomography scan demonstrated an odontoid nonunion. Radiographs of a previous cervical spine injury 2 years before demonstrated a missed odontoid fracture. The child was initially treated conservatively with halo vest immobilization, which did not result in healing. Direct anterior screw fixation was performed and the fracture united 5 months following surgery. The nonunion was asymptomatic for 2 years until the second injury when it became clinically symptomatic. It did not respond to conservative treatment and was unstable on screening requiring operative intervention. Very few cases have been reported of pediatric odontoid nonunions. If the fracture pattern allows, then direct anterior screw fixation should be considered in order to maintain range of motion at the atlantoaxial articulation.