Anterior Odontoid Screw, Single Institutional Experience in Tertiary Care Center in Developing Country

Objective: This study was done to evaluate clinical picture, radiographic findings and results of anterior odontoid screw fixation in cases of odontoid fracture, using one hollow titanium odontoid screw, according to our limited facilities in absence of intraoperative neuronavigation or O-arm using only one C-arm to ensure ideal trajectory.

Method: The present study included 14 patients, 10 males and 4females. Their ages ranged from 19 to 56 years. Instability resulted from fracture of the odontoid process type II in 12 cases, and type III in 2 cases. Single hollow titanium anterior odontoid screw was used in fixation using only one C-arm intraoperative to ensure ideal trajectory. Postoperative Philadelphia neck collar was applied for 8-12 weeks. Outcome Measures included radiological evaluation of successful bone fusion, neurological evaluation using the American Spinal Injury Association (ASIA) motor score, neck and arm pain scoring, and neck disability index (NDI). Evaluations were conducted preoperatively and at end of follow-up period which ranged from 6 to 12 months.

Results: Postoperative evaluation revealed that 50% of patients improved, while 50% of patients remained at the same ASIA score as pre-operative. Pain and neck disability scores were reduced postoperatively compared with preoperative. Fusion was achieved in 13 cases (93%) at last follow-up. Instrumentation failure occurred in only one case due to screw break.