Odontoid screw fixation of a type II odontoid fracture in a patient with autofused C2–C3 vertebral bodies

Abstract

Abstract Background Anterior odontoid screw fixation for the treatment of type II odontoid fractures, in contrast to posterior C1–2 fusion, allows for maintenance of cervical rotatory motion at C1–2. The approach requires an accessible C2–3 disc space from which a screw can be inserted into the vertebral body and odontoid process across the fracture. Less is known about the potential use of this technique in patients with inaccessible C2–3 disc spaces. Case description A 20 year-old female presented to the emergency department following a motor vehicle accident with diffuse neck pain in the absence of weakness or paresthesias. A CT of the patient's C-spine revealed a type II dens fracture with 3 mm of posterior displacement and congenital fusion of the C2 and C3 vertebral bodies. She was initially treated conservatively with a halo brace for 3 months, but experienced persistent neck pain and a CT of the C-spine at that time showed incomplete healing. The patient was counseled and elected to undergo anterior odontoid screw fixation. During the procedure, due to the autofusion of the C2–3 vertebral bodies, the C3–4 disc space was accessed and a screw was placed through the C2–C3 fusion block into the odontoid process. The patient tolerated the procedure well and postoperative imaging demonstrated healing of the fracture fragments. Conclusion This case demonstrates that patients with inaccessible C2–3 disc spaces can still undergo anterior fixation. In younger patients, this may be particularly valuable as the rotatory potential of their cervical spine is preserved.