• Gaurav Tyagi, Kautilya R Patel, Gyani Jail Singh, UpparAlok MohanAMDepartment of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India., Manish Beniwal, Kannepalli Venkata Lakkshmana Narsinga Rao, Nupur Pruthi, Dhananjaya Bhat, Sampath Somanna, Bangalore Chandramouli, and Srinivas Dwarakanath.
• Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India.
• World Neurosurg. 2021 Aug 1; 152: e279-e288.

ObjectiveType II odontoid fractures are the commonest C2 fractures. The management of dens fractures remains controversial with various radiological and fracture morphological factors affecting the approach and outcomes.MethodsAll cases of anterior odontoid screw fixation between 2010 and 2020 were retrospectively analyzed. Patients' clinical, radiological (type of fracture, orientation, displacement, and diastasis), operative (single vs. double screw) and follow-up records were documented. The postoperative imaging findings were classified into grades I (excellent), II (good), and III (poor) based on the anatomical alignment with the screw. Follow-up cervical computed tomography was reviewed for fracture union.ResultsA total of 49 patients with a mean age of 37.3 ± 13.8 years were included in the study. The average time from injury to surgery was 23.1 ± 22.2 days. The bicortical screw purchase and superoposterior odontoid tip breach significantly affected the postoperative alignment (P = 0.035 each). Fracture union was noted in 41 (83.7%) patients. The horizontal fracture displacement ≥2.5 mm (P = 0.02) and poor postoperative fracture alignment (P < 0.001) resulted in worse fracture union rates. Transient dysphagia was the commonest complication (n = 12), whereas screw breakout (n = 2) and pullout (n = 2) were other hardware-related complications. One patient underwent re-exploration for screw readjustment and 2 underwent posterior instrumentation.ConclusionsAnterior odontoid screw fixation is technically straightforward, less morbid, and preserves biomechanical cervical mobility, when compared with the posterior instrumentation. With careful patient selection, meticulous surgical planning, and intraoperative image-guided screw insertion, good fracture union outcomes can be obtained. In the current study, we were able to achieve stable fracture union in 83.7% patients.Copyright © 2021 Elsevier Inc. All rights reserved.

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