Case Report: posterior approach with sub-laminar wiring as management of comminuted fracture of the odontoid process of the axis

Abstract

Background: Odontoid fractures (OF) account for 5-18% and 10-19% of all injuries at C2 and in the cervical region, respectively. According to the Anderson and D'Alonzo classification, there are three main types of OF: Type I, II and III. Most cases involving OF of the axis by high impact trauma result in death. Case presentation: A 21-year-old male patient, with comminuted OF caused by a high impact traffic accident. On admission, the patient reported moderate to severe pain in the posterior craniocervical junction, with significant limitation to lateral rotation of the head and severe cervical muscle spasm. There was evidence of comminuted OF of C2 without apparent displacement in the cervical region. The patient underwent surgery via a posterior approach with double sub-laminar wiring between C1 and C2. The procedure was considered to be completely resolutive with no postoperative complications or sequelae, with total recovery of the patient's functionality. Discussion: The posterior approach is a viable option when the anterior approach is not possible due to the nature of the comminuted fracture and risks of complications, even when it involves a degree of compromise in the rotation of the C1-C2 joint. OF is a medical emergency, requiring individualized treatment tailored to the characteristics of the patient. There are currently no standardized treatment guidelines for OF.