Versatility of Anterior Approach for Management of Odontoid Fractures

Abstract

Background Data: Odontoid fractures comprise about 20 % of all cervical fractures. Odontoid fractures have been classified according to Anderson and D'Alonzo classification system. Anterior and posterior approaches can manage odontoid fractures, and various schools of thought favor both approaches. This article highlights the versatility of the anterior approach to treat varying types of odontoid fractures. Indications for surgical management include the age of the patient more than 55 years, displacement of fracture fragment more than 4 mm, nonunion, and disruption of the transverse atlantal ligament. The odontoid has 55% less trabecular bone than the body of the axis. This trabecular bone is required for callus formation and bone healing; hence, nonunion of type 2 fractures is more common than that of type 3 fractures. Purpose: To present different anterior methods of managing odontoid fractures. Study Design: A case report. Patients and Methods: In the present report, we have deployed three different techniques using the anterior approach for the fixation of the odontoid fracture. Plate and screw fixation is far more effective as the odontoid is a non-weight-bearing structure, and it compresses the fragments for a better union. Results: In all three cases, we found good evidence of radiographic healing of the fracture in the postoperative period with no significant immediate or delayed complications. Neck mobility was limited to some extent with the placement of transarticular screws but was preserved completely in the other two patients. Conclusion: Anterior cervical approaches in odontoid fractures carry safe and promising results in achieving solid fusion, less operative risk to vital structures, and preserving the cervical range of motion. The learning curve is also shallow compared to posterior approaches. (2022ESJ262)