Type II odontoid fracture: A case series highlighting the treatment strategies

Background: A type II odontoid fracture, if unstable, can cause spinal cord damage. In this case, it is essential to choose the correct treatment—but the issues of what the correct treatment is and which of the different surgical options is best are quite controversial. In this paper we present strategies for treatment of type II odontoid fracture. Materials and Methods: Thirty consecutive cases of type II odontoid fracture were treated at the Division of Neurosurgery at Villa Sofia Hospital in Palermo (23 cases) and at the Neurosurgical Clinic, University Hospital of Palermo (seven cases), from January 2011 to August 2016. Four patients were treated with external immobilization. Twenty-six patients underwent a surgical procedure. Results: There was no mortality related to the surgical procedure. One patient had a pre- and postoperative neurological deficit, and remained tetraparetic. Follow-up radiological studies in the surgically treated group showed bone union in 21 patients and stable fibrous union in one. Conclusion: In our and other authors’ experience, when the direction of the fracture line is down and forward, external immobilization can be sufficient for healing. Anterior odontoid screw fixation can be considered the treatment of choice for unstable odontoid fractures (with a horizontal, down and back, or comminuted fracture line) without dislocation or with dislocation less than 7 mm. When the odontoid fracture is associated with a Jefferson fracture or dislocation greater than 7 mm, stabilization of C1–C2 may be necessary. In this case, placement of screws in the dens and in the joints through a single approach represents the most valid technique. In the case of an inveterate fracture of the dens with severe C1–C2 dislocation, the surgical operation that offers the best prospects is posterior stabilization, utilizing the Guo technique.