Posterior C1-2 Temporary Fixation without Fusion for Recent Odontoid Fractures

Abstract

ABSTRACT BACKGROUND: Posterior C1-2 fusion techniques are the commonly used treatment for odontoid fracture. But this is usually associated with limitation in the cervical spine range of motion especially the rotational motion. Posterior C1-2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. OBJECTIVE: To assess the clinical and radiological outcome of the posterior C1-2 temporary fixation technique in the treatment of a new odontoid fracture. STUDY DESIGN: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. PATIENTS AND METHODS: 12 consecutive patients, suffering from Type II odontoid fracture. The age ranged between 15-43 years old with a mean age was 24±11.6 years old, eight were male and four females. All cases were post traumatic. Eight patients were dislocated and four cases were in place. Only two patients were suffering from partial neurologic deficit pre-operative. The second surgery was done after a mean 15.5 weeks from the first surgery. RESULTS: The radiological outcome showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°, using multi slice thin cuts CT scan. Significantly better functional outcomes were observed after the temporary-fixation removal using visual analog scale score (VAS) for neck pain (P=0.0033), neck stiffness and the patient satisfaction. CONCLUSION: Posterior atlanto-axial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved.