Minimally invasive technique of triple anterior screw fixation for an acute combination atlas-axis fracture: case report and literature review.

Abstract

A case report to describe the minimally invasive technique of treating C1-type II odontoid combination fractures. To introduce a new, minimally invasive technique of triple anterior screw fixation for acute combination atlas-axis fractures. Management for C1-type II odontoid combination fractures includes traction, immobilization and posterior fusion with and without instrumentation and anterior odontoid screw fixation. The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. A case of combination atlas-type II odontoid fracture occurred in a 39-year-old man. Imaging examinations showed a fracture of the unilateral anterior and posterior arch of C1 associated with type II odontoid fracture and with significant prevertebral soft tissue edema. Treatment consisted of odontoid and bilateral C1-C2 transarticular screw fixation through bilateral anterior small incisions. The patient was mobilized early postoperatively with a hard cervical collar and discharged 4 days later. On 2-year follow-up, he presented no cervical complaints and only mild reduction in neck rotation. In case of C1-type II odontoid fracture, the triple anterior screw fixation can be taken into consideration as an alternative because of its superiority of minimal invasion, stability and safety.