Anterior Odontoid Screw Fixation

Odontoid fractures comprise 10%-15% of all cervical fractures in adults, of which Anderson and D'Alonzo type II odontoid fractures are the most common subtype. Anterior screw fixation for type IIB odontoid fractures is a safe and effective treatment option in the properly selected patient. This less invasive technique preserves the C1-C2 motion while stabilizing the dens and yields a high union rate with minimum morbidity in appropriately indicated patients. Younger patients and nonosteoporotic patients with anterior superior to posterior inferior (type IIB) fracture patterns are ideal candidates. The authors recommend using a noncannulated system with a single fully threaded screw and a lag technique to achieve bicortical fixation across the fracture. This paper presents an anterior odontoid screw fixation for type II odontoid fractures with a detailed technical guide in written and accompanying video format. We also discuss appropriate indications, contraindications, complications, and technical pearls. The full video illustrating this surgical technique and approach can be found at: https://www.youtube.com/watch?v=HKW4JO3HBxo&list=PL_UtVTe4NFuIYo3BabDnWtCiInnkelbJy&index=6.