Minimally Invasive Percutaneous C1-C2 Fixation Using an Intraoperative Three-Dimensional Imaging–Based Navigation System for Management of Odontoid Fractures

Abstract

Odontoid fractures are the most common lesions of the upper cervical spine in patients >70 years old. These fractures are associated with frequent comorbidities, and minimally invasive techniques might have the potential to reduce postoperative complications while ensuring better precision. The aim of this study was to report an innovative technique and preliminary results of minimally invasive atlantoaxial fixation using a three-dimensional intraoperative navigation system and percutaneous approach. This retrospective study included 5 consecutive patients with an acute traumatic odontoid type II fracture managed using a percutaneous Harms fixation under three-dimensional intraoperative navigation guidance. C1 lateral mass screws and C2 isthmus screws were successfully placed in all patients. In all cases (100%), adequate screw positioning with no medial breach and no transverse foramen obstruction was observed. No intraoperative complications, such as injury of the vertebral artery, spinal nerve root, or spinal cord, occurred. None of the 5 patients received blood transfusion during or after the procedure. During the follow-up period (mean, 11.2 months; range, 5-16 months), 4 patients (80%) demonstrated a favorable clinical recovery, and only 1 patient required occasional medication for moderate pain. Mean radiation exposure was 4.83 mSV for each patient and 0 mSv for surgical staff. Minimally invasive atlantoaxial fixation using an intraoperative three-dimensional navigation system is a safe and effective alternative to the conventional approach that reduces postoperative morbidity.