Abstract
Anterior screw fixation is a standard treatment procedure in the case of an uncomplicated Anderson-D'Alonzo type II odontoid fracture in younger patients. Insufficient bony screw hold can cause severe procedure-related complications and result in screw breakouts with secondary fracture dislocation. Hence, the procedure is limited to patients with an adequate bone mineral density. This case report summarises a technical modification of anterior screw fixation in elderly patients suffering from severe osteoporosis to avoid a posterior spondylodesis of C1/2. Two patients with odontoid fractures of Anderson-D'Alonzo type II were operated using anterior screw fixation and additional vertebroplasty of C2 to increase the screw hold. During follow-up a regular bony healing without screw complication was observed. In conclusion, cement-augmented anterior screw fixation of odontoid fractures type II according to Anderson-D'Alonzo and persistent severe osteoporosis can be an alternative to posterior C1/2 spondylodesis in individual cases.
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