Simultaneous anterior and posterior screw fixations confined to the axis for stabilization of a 3-part fracture of the axis (odontoid, dens, and hangman fractures): report of 2 cases

J Neurosurg Spine. 2014 Mar;20(3):265-9. doi: 10.3171/2013.12.SPINE12448. Epub 2014 Jan 10.

Abstract

Fractures of the axis are considered to be one of the most common injuries to the cervical spine, accounting for more than 20% of all cervical spine fractures. Multiple fractures of the axis are much rarer, accounting for 1% of all cervical fractures. Management of such complex fractures is still challenging, and there is no strong consensus for the treatment. The authors describe the cases of 2 patients who presented with 3-part fractures of the axis consisting of an odontoid Type II fracture and a Levine-Edwards Type IA fracture, which were treated with concurrent insertion of an anterior odontoid screw and bilateral posterior pedicle screws. The cases presented were characterized by 1) a Type II odontoid fracture; 2) a Type IA traumatic spondylolisthesis with no or a little translation and angulation of C-2 on C-3 in a ring fracture of the axis; and 3) no disorders at the C2-3 disc on MR images. Therefore, the authors performed surgery confined to the axis by concurrently inserting an anterior odontoid screw and posterior bilateral pedicle screws without arthrodesis of C2-3. This was followed with cervical soft collar fixation for only 1-2 weeks. The outcomes were favorable, including good osteosynthesis, high primary stability, early patient mobilization, and preserved range of motion of the cervical spine at C2-3 as well as at C1-2.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Bone Screws
  • Fracture Fixation, Internal / instrumentation
  • Fracture Fixation, Internal / methods
  • Humans
  • Joint Instability / pathology
  • Joint Instability / surgery*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Odontoid Process / injuries*
  • Odontoid Process / pathology
  • Odontoid Process / surgery*
  • Spinal Fractures / pathology
  • Spinal Fractures / surgery*
  • Spinal Fusion / instrumentation
  • Spinal Fusion / methods*