Surgical Treatment of Odontoid Type II Fracture with Anterior Screw Fixation: Analysis of 15 Cases

Kim, Jong Moon; Jahng, Tae Ahn

Abstract

Fracture of the odontoid process is subdivided into type I, II and III. The treatment of type II is problematic, in that both conservative treatment and surgery are usually unsatisfactory; in the other type, conservative management alone gives good results. Recently, however, the operative procedure has changed, in accordance with advances in surgical equipment and technique. The anterior or posterior approach may be used, and the anterior screw fixation is increasingly the operaive procedure of choice; indications, operative technique, complications and long-term prognosis have not, however, been reported. The procedure was initially applied to patients who had suffered posterior displacement, and in whom nonunion was likely, but because of improved equipment and technique, was seem to be succesful and safe and so was used in the initial management of all odontoid type II fracture. A anterior screw fixation effectively attaches displaced bony fragment to the odontoid process and immobilizes one that is fractured. The BOP(Biocompatible Osteoconductive Polymer) pin is more physiologic than metal screw, and does not compromise the area to be fused, eventhough it has no lag effect. The major advantages of anterior fixation are immediate stability and restoration, and the preservation of normal biomechanics of the spine. It can be used as the procedure of choice in most patients with odontoid type II fracture, while anterior fixation with a BOP pin may be suitable for some selected patients.