3 Odontoid Fixation

Relative: any Anderson and D’Alonzo type II fracture (Fig. 3–1) Absolute: Type II fracture with:

1. Greater than 4 mm displacement

2. Greater than 10 degrees of angulation

3. Age greater than 40

4. Posterior displacement

5. Multiple trauma

6. Nonunion

Contraindications

1. Failure of closed reduction

2. Osteopenia

3. Chronic obstructive pulmonary disease (COPD) with chest wall obstruction

4. Cervicothoracic kyphosis

5. Inadequate fragment size

6. Obliquity—anterior caudal to posterior cranial—without buttress plate

7. Os odontoideum

8. Inability to extend neck—spinal stenosis or limited cervical motion

Advantages of Odontoid Fixation

1. Direct repair of fracture

2. Preservation of C1-C2 motion

3. Restoration of bony spinal anatomy

4. Immediate stability

5. Obviate halo

6. Earlier rehabilitation

7. Anterior approach less traumatic than posterior surgery

8. Can be used with C1 posterior ring fractures

9. Higher union rate

10. Lower cost

Disadvantages

1. Technically demanding.

2. Requires two-plane fluoroscopy and extensive setup.

Procedure

Positioning

1. Place patient in supine position.

2. Perform awake nasotracheal intubation with slight neck extension.

3. Sedate patient.

4. Apply Mayfield three-point head holder with local anesthesia.

5. Attach Mayfield to horizontal U-shaped crossbar for AP imaging (Fig. 3–2).

6. Position AP/lateral fluoroscopy unit with monitor opposite the operating surgeon.

7. Ensure that anatomic reduction and an unobstructed drill approach angle has been achieved; image the Kirschner wire (K-wire) superimposed over the screw trajectory.

8. Perform modified wake-up test with patient moving all four extremities.

9. Administer general anesthesia.

10. Place radiolucent bite block for AP imaging.

Exposure

1. Perform a Smith-Robinson retropharyngeal approach at the C5-C6 level.

2. Carry the exposure to the C2-C3 level.

3. Insert Cloward retropharyngeal retractors.

Related posts:

Posterior Cervical Laminectomy and Fusion Posterior Cervical Plating Techniques Anterior Thoracoscopic Release for Spinal Deformity Anterior Cervical Corpectomy Anterior Lumbar Interbody Fusion Total Lumbar Disc Replacement Using the SB III Charite Prosthesis

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