Retropharyngeal Approach Research Articles

Not Every Size Fits All: Surgical Corridors for Clival and Cervical Chordomas-A Systematic Review of the Literature and Illustrative Cases.

Introduction. Clival chordomas represent a rare but clinically significant subset of skull base tumors, characterized by a locally aggressive nature and a location in proximity to vital neurovascular structures. Surgical resection, often combined with adjuvant therapies, remains the cornerstone of clival chordoma treatment, and various approaches and techniques have evolved to maximize tumor removal while preserving neurological function. Recent advancements in skull base surgery, imaging, and adjuvant therapies have improved outcomes by reducing morbidity and thus enhancing long-term survival. Methods and Results. We have conducted a systematic review on PubMed/Medline following PRISMA guidelines regarding indications, the extent of resection (EOR), and complication rates. Then, we present three illustrative cases from our personal experience, which started 25 years ago with CVJ instrumentation procedures and 15 years ago with anterior decompressive transmucosal procedures performed with the aid of an operative microscope, an endoscope, and neuroradiological monitoring. Conclusions. Traditionally, the transoral approach (TOA) is the most frequently used corridor for accessing the lower clivus and the anterior craniovertebral junction (CVJ), without the need to mobilize or retract neural structures; however, it is associated with a high rate of complications. The endonasal approach (EEA) provides access to the anterior CVJ as well as to the lower, middle, and superior clivus, decreasing airway and swallowing morbidity, preserving palatal function, decreasing postoperative pain, and reducing the incidence of tracheostomy. The submandibular retropharyngeal approach (SRA) allows unique access to certain cervical chordomas, which is better suited when the lesion is located below the clivus and in the midline.

Endoscopy-assisted high cervical anterolateral retropharyngeal approach to clivus: a cadaveric study.

The surgical management of pathologies involving the clivus and craniocervical junction has always been considered a complex procedure because of the deeply located surgical targets and the surrounding complex neural and vascular anatomical structures. The most commonly used approaches to reach this area are the transnasal, transoral, and transcervical approaches. This approach was performed unilaterally on five cadaver heads and bilaterally on one cadaver head. We described a modified endoscope-assisted high cervical anterolateral retropharyngeal approach in which each stage of the procedure was demonstrated on human cadavers in a step-by-step manner using endoscopic camera views. This approach was broken down into nine steps. The neurovascular structures encountered at each step and their relationships with each other are demonstrated. The advantages and disadvantages of our modified approach were compared to the conventional transcervical, transoral, and endoscopic endonasal approaches.

A Three-Step Submandibular Retropharyngeal Approach to the Craniovertebral Junction: Is Less Always More?

Background: Accessing the craniovertebral junction poses unique challenges due to its anatomical complexity and proximity to critical structures, such as the cord-brainstem junction, great vessels of the neck, cranial nerves, oropharynx, and rhinopharynx. Among the approaches that have been developed over the years, the submandibular retropharyngeal approach offers good antero-lateral access without the need of transgressing mucosal layers. In its traditional form, however, this approach involves multiple sequential steps and requires intricate dissection, extensive retraction, and meticulous maneuvering, which can increase operative time and produce approach-related morbidity. Methods: With this paper, we propose a simplified technique for a submandibular retropharyngeal approach involving only three surgical steps. The advantages and limitations of this technique are illustrated through three surgical cases of neoplastic and degenerative craniovertebral junction pathologies. Results: In two out of the three cases, our technique allowed for a wide exposure of the lesions that could be resected totally or sub-totally with good outcome. In one case with involvement of the clivus and the occipital condyle, the exposure was inadequate; a biopsy was obtained, and the lesion was subsequently resected via and endoscopic transmucosal approach. Conclusions: Our technique represents a significant simplification of the traditional submandibular retropharyngeal approach; with appropriate indication, it permits a fast, safe, and adequate exposure of craniovertebral junction pathologies.

Anterior retropharyngeal approach (ARPA) for high cervical spine.

One of the major challenges in operating on the spine lies in taking an anterior approach for the high cervical spine. In patients with a short neck, Klippel-Fiel syndrome or when the C3 vertebra is high in relation to the hyoid bone, it will be difficult to access the C3 body. The transoral route is a highly contaminated zone, and therefore, no instrumentation or grafts can be placed through it. The anterior retropharyngeal approach (ARPA) for the high cervical spine. The anterior retropharyngeal approach is an excellent approach for the high cervical spine where instrumentation is needed. This route provides wide exposure of the C1-C3 region, avoiding the contaminated of the oral cavity.

Transcervical, retropharyngeal odontoidectomy - Anatomical considerations.

Anterior craniocervical junction lesions have always been a challenge for neurosurgeons. Presenting with lower cranial nerve dysfunction and symptoms of brainstem compression, decompression is often required. While posterior approaches offer indirect ventral brainstem decompression, direct decompression via odontoidectomy is necessary when they fail. The transoral and endoscopic endonasal approaches have been explored but come with their own limitations and risks. A novel retropharyngeal approach to the cervical spine has shown promising results with reduced complications. This study aims to explore the feasibility and potential advantages of the anterior retropharyngeal approach for accessing the odontoid process. To investigate the anatomical aspects of the anterior retropharyngeal approach, a paramedian skin incision was performed below the submandibular gland on two cadaveric specimens. The subcutaneous tissue followed by the platysma is dissected, and the superficial fascial layer is opened. The plane between the vascular sheath laterally and the pharyngeal structures medially is entered below the branching point of the facial vein and internal jugular vein. After reaching the prevertebral plane, further dissection cranially is done in a blunt fashion below the superior pharyngeal nerve and artery. Various anatomical aspects were highlighted during this approach. The anterior, submandibular retropharyngeal approach to the cervical spine was performed successfully on two cadavers highlighting relevant anatomical structures, including the carotid artery and the glossopharyngeal, hypoglossal, and vagus nerves. This approach offered wide exposure, avoidance of oropharyngeal contamination, and potential benefit in repairing cerebrospinal fluid fistulas. For accessing the craniocervical junction, the anterior retropharyngeal approach is a viable technique that offers many advantages. However, when employing this approach, surgeons must have adequate anatomical knowledge and technical proficiency to ensure better outcomes. Further studies are needed to enhance our anatomical variations understanding and reduce intraoperative risks.

The Submandibular Approach: A Descriptive Perspective of the Retropharingeal Corridor to the Craniocervical Junction (Microscopic- vs. Endoscopic-Assisted Dissections).

The craniocervical junction refers to an area from the line separating the middle and lower third of the clivus to the base of the dens (anteriorly) and from the posterior edge of the occipital foramen to the spinous process of C2 (posteriorly). Here, the clival region is a challenging surgical target surrounded by a complex neurovascular architecture. Historically, mainly the complex, and high-risk, transmucosal approaches have been the corridors of choice when targeting this region. Nevertheless, the inherent broad anatomic and pathological variants have shown the need for more-malleable and wider approaches. Thus, MacAfee's established retropharyngeal approach has been simplified in parallel to the application of endoscopic surgery, therefore providing access to the clival region through a low-risk retropharyngeal space when compared to homologous anterior transmucosal approaches. The following review analyzes the literature that has specifically described the craniocervical junction after reaching the clivus (or at least after odontoidectomy) through the retropharyngeal corridor, from the perspective of the open approach or the endoscopic submandibular approach.

Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh.

Surgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs. We performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status. The 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach (p < 0.05). Group A had a higher complication rate than group B (p < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%). Total resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.

Modified anterior retropharyngeal approach for C2-C3 disc herniation.

C2-C3 disc herniations are rare, but occur more frequent in the elderly population. As the classical anterior Cloward approach to these lesions is not optimal, we propose an alternative modified retropharyngeal approach to these disc herniations that were successfully utilized in two patients. Two patients with C2-C3 disc herniations underwent anterior cervical surgery utilizing the modified retropharyngeal approach. Surgery was successful is two cases with C2-C3 disc herniation and no patient sustained a perioperative complication. Our modified anterior retropharyngeal approach for C2-C3 disc herniations resulted in good outcomes without perioperative complications.

Full-Endoscopic Anterior Odontoid Screw Fixation: A Novel Surgical Technique.

ObjectiveFirst, to propose a novel minimally invasive technique of full‐endoscopic anterior odontoid fixation (FEAOF) that aims to reduce the risk of retropharyngeal approach (both open and percutaneous techniques) to anterior odontoid screw fixation. Second, to describe steps of the procedure and, lastly, to report the initial outcomes in patients treated with this novel technique.MethodsFour non‐consecutive patients who were diagnosed with a displaced odontoid fracture (Anderson‐D'Alonzo classification type II and Grauer subclassification type A or B) from 2019 to 2020 underwent surgical fixation by our novel technique for anterior odontoid screw fixation. A detailed technical approach of FEAOF for the surgical treatment of type II odontoid fractures was described, and the patients' outcomes based on postoperative radiographic results including computed tomography (CT), clinical outcome parameters including visual analogue scale (VAS) for neck pain both preoperatively and at postoperative follow‐up, and range of neck motion at the final follow‐up were reported.ResultsThe mean age was 33.5 years (24–41), three patients were male. The mean operative time was 93.75 min, and the mean blood loss was 7.5 ml. An immediate post‐operative thin‐sliced CT showed that all patients achieved satisfactory reduction and proper screw position. No screw malposition or penetration was found. At a 6‐month follow‐up, a thin‐sliced CT demonstrated solid bony union in every case. The mean VAS for neck pain was reduced from 6.5 to 0.6 at the 6‐months follow‐up. At the final follow‐up, all patients showed improvement in ranges of motion without any complications; however, one patient was lost to follow‐up.ConclusionsFEAOF is a feasible and effective option for treating type II odontoid fractures. The procedure is less invasive than other techniques and provides clear direct visualization of the involved structures.

Anterior transcervical release with posterior atlantoaxial fixation for neglected malunited type II odontoid fractures.

Background: Type 2 odontoid fractures are associated with a high rate of nonunion without surgical treatment. If neglected, they may become fixed in an abnormal position, causing progressive myelopathy. Conventionally, odontoidectomy or transoral release is performed to relieve symptoms in such cases. Here, were report our experience with a transcervical approach for odontoid release (i.e., of a chronically fractured dens) followed by a posterior C1–C2 fusion.Methods: The 11 patients (2017–2021) retrospectively included; in this study, all had a history of remote trauma and the radiological appearance of an old odontoid fracture that was displaced and could not be reduced with traction. There were eight males and three females who averaged 52.6 years of age.Results: All 11 patients underwent anterior retropharyngeal release with a C4–C5 level incision followed by a posterior C1–C2 fusion. The mean Japanese orthopedic association on presentation was 9.9 ± 2.7 which improved to 13.8 ± 2.7 on final follow-up (P < 0.01). Patients were followed an average of 9.6 months ± 4.4 (mean ± SD) postoperatively during which time they all clinically improved.Conclusion: Anterior release through a retropharyngeal approach coupled with posterior C1–C2 instrumentation proved to be an effective alternative to the traditional transoral approach to treat a chronic malunited odontoid fracture.

Retropharyngeal Reduction Plate for Atlantoaxial Dislocation: A Cadaveric Test and Morphometric Trajectory Analysis.

ObjectiveTo evaluate the placement feasibility and safety of the newly designed retropharyngeal reduction plate by cadaveric test and to perform morphometric trajectory analysis.MethodsThe five cadaveric specimens with intact atlantoaxial joint were enrolled in this study. They were used for simulating the placement process and evaluating the placement feasibility of the retropharyngeal reduction plate. The atlantoaxial dislocation (AAD) of five cadaveric specimens were obtained by proper external force after dissecting ligaments. The retropharyngeal reduction plate was placed on atlantoaxial joint of cadaveric specimens. The X‐ray and three‐dimensional (3D) spiral CT were used for evaluating the placement safety of retropharyngeal reduction plate. The DICOM data was obtained after 3D spiral CT scanning for the morphometric trajectory analysis.ResultsThe reduction plates were successfully placed on the atlantoaxial joint of five cadaveric specimens through the retropharyngeal approach, respectively. The X‐ray and 3D spiral CT showed the accurate screw implantation and satisfying plate placement. The length of the left/right atlas screw trajectory (L/RAT) was, respectively, 1.73 ± 0.01 cm (LAT) and 1.71 ± 0.02 cm (RAT). The length of odontoid screw trajectory (OST) was 1.38 ± 0.02 cm. The length of the left/right axis screw trajectory (L/RAXT) was, respectively, 1.67 ± 0.02 cm (LAXT) and 1.67 ± 0.01 cm (RAXT). There was no statistical significance between left side and right side in terms of AT and AXT (P > 0.05). The angles of atlas screw trajectory angle (ASTA), axis screw trajectory angle (AXSTA), and odontoid screw trajectory angle (OSTA) were 38.04° ± 2.03°, 56.92° ± 2.66°, and 34.78° ± 2.87°, respectively.ConclusionThe cadaveric test showed that the retropharyngeal reduction plate is feasible to place on the atlantoaxial joint, which is also a safe treatment choice for atlantoaxial dislocation. The meticulous preoperative planning of screw trajectory based on individual differences was also vital to using this technique.

Island sternocleidomastoid myocutaneous flap for posterior pharyngeal wall defect repair after anterior cervical spine surgery.

Injuries and tumours of the cervical spine represent therapeutic challenges to the treating surgeon due to the complex anatomical relationships and biomechanical features. The anterior cervical midline (ACM) and anterior cervical retropharyngeal (ACR) approaches are effective and safe surgical approaches for certain cervical spine lesions, such as cervical spine neoplasms, atlantoaxial subluxation, and certain odontoid fractures. Posterior pharyngeal wall defects (PPWDs) is one of the most frequently encountered surgical morbidities after anterior cervical spine surgery (ACSS). However, limited information has been published concerning effective approaches for PPWD reconstruction after ACSS. The manuscript aimed to describe a novel application of the island sternocleidomastoid myocutaneous flap (ISMF) in the management of PPWDs after ACSS, including surgery with the ACM approach and ACR approach. From April 2015 to November 2019, the clinical data of three patients with PPWDs repaired using the ISMF in Peking university third hospital were retrospectively analysed. The observational indexes are as follows: postoperative survival of the flap, wound healing 2 weeks after surgery, eating and pronunciation function 2 months after surgery. The above indexes of these three cases recovered well. Three patients did not have any persistent PPWD after repair with the ISMF and did not require any further surgical procedures related to the cervical spine.

Atlantoaxial Dislocation: Surgical Outcome following Anterior Retropharyngeal Approach to Odontoid with or without Fixation

Abstract Introduction Atlantoaxial dislocation (AAD) refers to a loss of stability between the atlas and axis vertebra. The conventional transoral approach and the anterior retropharyngeal approach (ARPA) are adequate for the upper cervical vertebral segments. This study was undertaken to evaluate the usefulness of the ARPA to the odontoid in patients of AAD. Materials and Methods The study was undertaken on 20 patients admitted in Nil Ratan Sircar Medical College and Hospital, Kolkata, India, with functional disability secondary to AAD. These patients underwent surgery through ARPA to odontoid with or without fixation. Patients were analyzed between October 2014 and September 2016. Results Maximum number of patients belonged to third decade of life. The male to female ratio was 1.5. The mean duration of symptoms was 10.86 months. Weakness of the upper and lower limbs predominated. About 65% patients had axial neck pain. Nine patients (45%) in total had difficulty in either bowel or bladder. Five patients presented with fracture odontoid and pannus formation of the odontoid process, while six had basilar invagination. One patient underwent anterior odontoid screw fixation and the other 19 patients underwent anterior retropharyngeal odontoidectomy with posterior fixation. Two patients expired in the present study. Most of the patients had improvement in Nurick grade during follow-up. Five patients had transient throat pain and dysphagia. Three patients had superficial surgical site infection. One patient had postoperative cerebrospinal fluid leak. Conclusion The ARPA to odontoid is a feasible approach for decompression and fixation of the odontoid in AAD cases.

Surgery for craniovertebral junction pathologies: minimally invasive anterior submandibular retropharyngeal key-hole approach

BackgroundOur objective was to develop a new, minimally invasive surgical technique for the resolution of craniovertebral junction pathologies, which can eliminate the complications of the previous methods, like liquor-leakage, velopharyngeal insufficiency and wound-dehiscence associated with the transoral or lateral approaches.MethodsDuring the first stage of the operation, three patients underwent occipito-cervical dorsal fusion, while the fourth patient received C1–C2 fusion according to Harms. C1–C2 decompressive laminectomy was performed in all four cases. Ventral C1–C2 decompression with microscope assisted minimally invasive anterior submandibular retropharyngeal key-hole approach (MIS ASR) method was performed in the second stage. The MIS ASR—similarly to the traditional anterior retropharyngeal surgery—preserves the hard and soft palates, yet can be performed through a 25 mm wide incision with the use of only one retractor.ResultsThe MIS ASR approach was a success in all four cases, there were no intra- and postoperative complications. This method, compared to the transoral approach, provided on average 23% (4.56 cm2/6.05 cm2) smaller dural decompression area; nonetheless, the entire pathology could be removed in all cases. After the surgery, all patients have shown significant neurological improvement.ConclusionBased on the outcome of these four cases we think that the MIS ASR approach is a safe alternative to the traditional methods while improving patient safety by reducing the risk of complications.

Free tissue transfer for central skull base defect reconstruction: Case series and surgical technique

ObjectivesLocal reconstruction of central skull base defects may be inadequate for large defects or reoperative cases; free tissue transfer may be necessary. Inset of the flap and management of the pedicle can be challenging. We report our experience and approaches. MethodsRetrospective review identifying seven patients with central skull base defects who underwent free flap reconstruction from 2016 to 2020. ResultsFour patients with recurrent nasopharyngeal carcinoma, one with recurrent craniopharyngioma, one with clival-cervical chordoma, and one with meningioma of the middle cranial fossa were analyzed. Six defects were closed with an anterolateral thigh free flap and one with a radial forearm free flap. In two patients, the flap was secured in an onlay fashion to the defect via a Caldwell-Luc transmaxillary approach. In one patient, the flap was passed transorally, and the pedicle was delivered into the neck via Penrose drain. In two patients, a parapharyngeal technique and in two others, a retropharyngeal was used for nasopharyngeal inset with endoscopic assistance. There were no flap failures, with an average follow-up time of 20.1 (range 3.2–47.1) months. One patient required flap repositioning on postoperative day three due to midline shift and intracranial contents compression. The transoral inset flap necessitated flap repositioning on postoperative day 13 to improve the nasopharyngeal airway. ConclusionFree flap reconstruction of the central skull base is challenging, but transmaxillary, transoral, parapharyngeal, and retropharyngeal approaches can be used with endoscopic assistance to ensure secure inset flap and avoid airway obstruction.

Retropharyngeal approach in cervical disc hernias

Aim: High-level disc hernias are rare pathologies encountered in clinical practice. Treatment is more difficult than other cervical disc hernias. In this study, we aimed to convey our clinical experience in C2-3 and C3-4 disc herniations, also presenting the complications we encountered during surgical treatment. Methods: In this retrospective cohort study, we reviewed the clinical and radiological records of 42 patients we operated between 2010-2019. Magnetic resonance imaging, computed tomography and direct radiographs were utilized as imaging modalities. Anterior retropharyngeal approach was the preferred surgical method. The modified Japanese Orthopedic Association (mJOA) score and Nurick Scale were used in clinical follow-up and physical examination of these patients. Results: Among all patients, the most common symptom was severe pain radiating from the neck to the occipital region. The mean age was 54.14 years. The average mJOA scores were 15.1 in the preoperative period and 17 in the postoperative sixth month. We observed that 83.3% of our patients had an mJOA recovery rate of fifty percent and above. All but seven patients’ complaints improved well after treatment. There was a negative correlation between symptom duration and recovery rate (P=0.003, Correlation Coefficient r=-0.449). The rate of recovery was lower in patients with a longer duration of symptoms. Three of our patients developed difficulty in swallowing after the operation and recovered within four weeks with diet and exercise. Conclusion: We determined that retropharyngeal approach is a safe option for disc hernias at the upper cervical level. However, long operation time and excessive retraction during surgery may lead to complications such as difficulty in swallowing due to the stretching of the neural structures.

Full-Endoscopic Transcervical Ventral Decompression for Pathologies of Craniovertebral Junction: Case Series.

Odontoidectomy is very effective for the decompression of the ventral craniovertebral junction (CVJ). Various approaches are available for the direct ventral decompression of the CVJ. Because there are many disadvantages of open transoral approach, endoscopic odontoidectomy was developed. There are 3 approaches in endoscopic odontoidectomy. We report transcervical retropharyngeal endoscopic approach for the ventral CVJ in this paper. Three patients with different pathologies received operations using this approach. The decompression was enough and surgical invasion was less in all patients. Each endoscopic approach has some advantages and different working regions due to their approach trajectories, but transcervical retropharyngeal approach is very familiar for our neurospinal surgeons and has a relatively large working area. This approach might have the chance to take the place of open transoral approach for endoscopic spinal surgeons.

Simplified four-step retropharyngeal approach for the upper cervical spine: technical note.

In this paper, we propose a simplified four-step retropharyngeal approach, whose aim is getting straight to the upper cervical spine minimizing complications. While the classical retropharyngeal approach includes about 11 steps, ours is a four-step approach: patient positioning, skin-platysma incision, hyoid bone superolateral dissection and retropharyngeal blunt exposure. We avoid several steps of the classical anterior retropharyngeal approach, particularly dissection of submandibular gland, facial veins, external carotid artery and thyroid artery, bellies of the digastric muscle, hypoglossal nerve, thyrohyoid membrane and the internal branch of superior laryngeal nerve. We have adopted this technique for five patients: two patients had a C2-C3 herniated disk with myelopathy, two patients had unstable Hangman fracture with no bone fusion after 2-month treatment with rigid collar, and one patient had a C2-C3 osteophyte with dysphagia. The intraoperative time needed for reaching the retropharyngeal space was 15 (first case), 9 (second case), 7min (third case-illustrative case-and fourth case), 8min (fifth case). No complications occurred. Our simplification, avoiding several steps, is simple, effective, safe, and rapid and requires a simple learning curve.

Anterior retropharyngeal cage distraction with atlantoaxial plate-screw fixation for basilar invagination with atlantoaxial dislocation

The unilateral submandibular anterior retropharyngeal approach in properly selected patients offers the possibility to expose both atlantoaxial joints adequately, abrade the endplates, and graft the joint spaces. The supine position in extension permits the use of wedge-shaped cages, which reduce the invagination and correct the dislocation. Adequate bone stock is available to rigidly fix the joints using an anterior plate-screw construct without any risk to the vertebral arteries. The approach preserves the posterior tension band and the C2 root. The technique is quick, simple, and safe, and results in solid fusion of the joints over time.The video can be found here: https://youtu.be/tT6j3Czy6tc

Anterior Single Odontoid Screw Fixation for Type II Odontoid Fractures: In A Cohort Study of 11 Patients and literature review.

Objective: We aim to demonstrate the fusion efficiency of anterior screw fixation technique in all types of type 2 odontoid fracture by presenting a study of 11 cases and updating the literature.Methods: Retrospectively we analyzed 11 (8 males and 3 females) patients with type 2 odontoid fracture treated through anterior odontoid screw fixation in the Neurosurgery Department of XXX University Hospital between 2015 and 2018. All patient records were evaluated with current clinical, neurophysiological examination, radiological studies, and results. In operation we used retropharyngeal approach of Robinson and Smith and created a gutter in the superior edge of C3 corpus for proper trajection of screw. The patients were followed over a minimum period of eighteen months with a range (18-24 months). Assessments of the union, nonunion, screw displacement and overall, with complications were all recorded.Results: 10 patients had no postoperative complication. Separation of odontoid fracture was observed in 1 patient after discharge from hospital, but during follow up period computerized tomography revealed fusion of the odontoid of the patient. Our patients had no any complication such as screw related problems, pseudo-arthrosis and dysphagia.Conclusion: We recommend surgical treatment in all cases of type 2 odontoid fractures, including the anterior oblique fracture. The method used in our study is more reliable for trajection of screw and suitable for type 2 odontoid fracture, also fusion rate is higher than the other techniques