Placement of a single anterior odontoid screw for type II odontoid fractures in a setting with limited resources

Abstract

Background: Treatment of odontoid fractures with odontoid screws is an established method for fusion. However, it is facilitated by using advanced equipment in the operating theatre not always available as in developing countries. Objectives: In this study we aim to outline the important key points for successful placement of odontoid screw in the absence of advanced tools, e.g. navigation or O-arm. Materials and methods: Fifteen patients suffering from type II odontoid fractures were managed with single odontoid screw. Reduction of the fractures was achieved. A simple instrument set was used with the help of a single plane image intensifier. Longitudinal incision was used in 4 cases, and transverse incision was used in the remaining eleven cases. Anatomical identification of the midline helped to mark the entry point. The entry point used was millimetres below the anteroinferior edge of the axis vertebra. A short-headed screw was used. Results: Road traffic accident was the only mechanism of trauma reported in our study. All of the patients were neurologically intact. All of the patients remained neurologically intact after the procedure. There were no instances of wrong trajectory of the screw in our study. During follow-up, we found good union of all the fractures. Only 2 cases suffered from mild dysphagia. Conclusion: Fixation of odontoid fractures by anterior odontoid screws appears to be a safe and feasible procedure even in underequipped theatres. Anatomical knowledge helps in determining midline. Various modifications can help in overcoming shortcomings.