Odontoid Screw Fixation

Indications

• Patients with acute type II odontoid fractures (< 6 months) and patients with fractures with either a transverse or an anterosuperior to posteroinferior fracture plane are the most favorable surgical candidates.

• Subacute, unstable type II odontoid fractures (for which alignment cannot be maintained with orthoses) and chronic nonunion type II odontoid fractures.

• Fractures with displacement of greater than 6 mm, which are unlikely to fuse with external immobilization.

• “Shallow” type III odontoid fractures, in which the fracture pattern extends only minimally into the vertebral body, nonunion develops, or if unstable with orthoses.

• Failure to maintain reduction in halo vest or inability to tolerate halo vest immobilization is another indication.

• Patients opposed to wearing a halo vest, patients who cannot tolerate a halo vest (e.g., because of psychological concerns, multiple additional fractures, etc.), or patients who prefer surgery over a halo vest.

• Elderly patients with type II odontoid fractures represent a treatment challenge because of comorbidities and varying degrees of osteopenia. However, fewer treatment failures and less morbidity are associated with surgical management compared with an external orthosis.

Contraindications