Direct Anterior Screw Fixation of Odontoid Fractures

A 76-year-old woman with no known significant medical issues had a ground-level fall in which her head struck the ground. She immediately had upper neck pain, for which she went to an emergency room. She had no neurological deficits on examination. A computed tomography (CT) scan demonstrated a type II odontoid fracture without significant displacement (Fig. 7.1). Direct anterior odontoid screw fixation was recommended to the patient for treatment, but she refused to undergo surgical intervention. The patient was, therefore, treated initially with a hard cervical collar. She returned to clinic at 1 week’s time with continued severe neck pain, and a lateral radiograph demonstrated anterior displacement of the dens fragment (Fig. 7.2). The patient chose to proceed with surgery for odontoid screw fixation (Fig. 7.3). At 1-month follow-up examination, her neck pain had completely resolved, and at 6 months, she had no motion at the fracture site on flexion-extension views of the spine.