J Minim Invasive Spine Surg Tech.  2021 Oct;6(2):156-160. 10.21182/jmisst.2021.00080.

Direct Anterior Screw Fixation in a Type II Odontoid Fracture with a Fused C2–C3: A Technical Report

• Kulkarni AG
• Kunder TS

• KMID: 2562097
• DOI: http://doi.org/10.21182/jmisst.2021.00080

Abstract

To describe an innovative technique of direct anterior screw fixation in type II odontoid fracture with a congenitally fused C2–C3 vertebrae. Direct anterior screw fixation for type II odontoid fractures restores C1–C2 rotatory movement and allows early rehabilitation. Conventionally this technique involves entry of the screw through the C2–C3 intervertebral space. The challenge in the described case was the absence of a working C2–C3 interspace. This is one of the first few reports of the use of the direct anterior screw approach in congenitally fused C2–C3 situation. An 18-year-old male suffered a post-traumatic Type II displaced odontoid fracture without any neurological deficits. This patient also had a congenitally fused C2–C3 vertebra. Direct anterior screw fixation was performed using the C3–C4 interspace with a 55ｘ3.5 mm partially-threaded-cannulated screw. The unusual long curvilinear trajectory owing to the fused C2–C3 vertebrae proved to be technically demanding. The patient tolerated the procedure well. Direct anterior screw fixation is a feasible option in type II odontoid fractures with congenitally fused C2–C3 vertebrae. The subtle modifications required for this procedure are use of a longer screw and entry point at the C3–C4 interspace.

Keyword

Type II odontoid fracture; C2–C3 fusion; Direct anterior CC screw; Minimally invasive spine surgery; Spine trauma