Abstract
Introduction
In some fractures of the odontoid process of the axis, the gold standard is anterior transaxial fixation if there is slight or none displacement. To minimize the damage of an opened surgery, we developed anterior percutaneous approaches.
Patients and Methods
From 1995 to 2014, 10 patients with traumatic fractures of the odontoid process of axis classified as type II and type III (according Anderson and Alonzo classification) underwent surgery. The anterior approaches fixation were performed using 1 cm incision. Cannulated instruments and screws were necessary to fix the odontoid process. In all patients, surgery was image guided.
Results
In eight patients (80%) the only one symptom when admitted was cervical pain without neurological deficit. Two patients (20%) also presented also quadriplegia. The unique complication concerning surgery was retropharyngeal pain in all patients during 2 or 3 days. In later evaluations, consolidation of the fracture was confirmed in all patients (100%). One patient admitted with quadriplegia improved. The other one never improved spontaneous ventilation and died 8 months later (10%).
Conclusions
The knowledge and development of some percutaneous techniques can be employed in patients with fractures of the dens of the axis. The use of cannulated screws and instruments is mandatory to perform the operation. This kind of surgery must be always under imaging guidance.