• Ze-Xin Chen, Hui Zhang, Nai-Feng Tian, Xiang-Yang Wang, Yan Lin, and Yao-Sen Wu.
• Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
• Medicine (Baltimore). 2017 Nov 1; 96 (46): e8509.

RationaleThe complication of iatrogenic distraction of odontoid fracture after anterior screw fixation has not been reported in the literature. We treated the patient with endoscopically assisted bone grafting with good results. The new technique was not reported in the management of odontoid fracture or nonunion before.Patient ConcernsA 22-year-old man presented with neck pain after a motorcycle crash. The cervical spine radiograph and computed tomographic scan demonstrated the base of dens displaced 2 mm anteriorly.DiagnosesRadiographic images showed a type II odontoid fracture.InterventionsThe patient was treated by percutaneous anterior screw fixation. The postoperative radiograph and CT demonstrated an iatrogenic distraction of the odontoid with a gap of 6 mm.The follow-up radiograph did not show any sign of bone union 1 month and a half later. A revision surgery was given by anterior endoscopically assisted bone grafting. The patient was encouraged to sit out of bed immediately after the surgery with the protection of a soft cervical collar for 3 months.OutcomesNo complications such as neural structures or vascular injuries were found. Bone union was achieved at the 1-year follow-up CT scans. Physical examination showed a full range of motion in the neck.LessonsWe reported a case of iatrogenic odontoid distraction that was managed by anterior endoscopically assisted bone grafting. It is a technically feasible and minimally invasive procedure.

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