The Potential Expanded Role of the Endoscopic Endonasal Approach for Complex Odontoid Fractures

Abstract

Objective: An odontoid fracture stabilization through an endonasal endoscopy-assisted anterior screw fixation approach (EEA) could represent a minimally invasive alternative to traditional treatment for type II Anderson-D'Alonso C2 fractures with radiological evidence of pseudoarthrosis after conservative treatment, with spinal realignment and motion preservation. Methods: From January, 2012 to September, 2013, three patients were submitted to a combined EEA screws fixation approach for an inveterate odontoid fracture, showed by preoperative radiological examinations. The operation consists in the anterior transcervical odontoid screw fixation combined, at the same session, with a transnasal endoscopic approach to the odontoid base for inflammatory pannus removal and positioning of bone chips compressed in-between the bone stumps. Finally, under endoscopic control and X-ray verification, the self-tapping screw is inserted up to the odontoid tip to assure the compression of the cleaned bone borders supplemented by good quality harvested bone chips and odontoid realignment. Results: A radiological follow-up revealed a regular ossification without any hardware failure and\or breakage. None of the patients required a subsequent posterior fixation. The full range of motion was preserved. Conclusions: In this preliminary experience, in case of inveterate odontoid fractures this combined approach could represent the possible solution for a very complex problem preserving spinal realignment and motion.