Transaxial Odontoid Fixation Combined With Modified Gallie Technique in Type II Odontoid Fracture

Abstract

Introduction: Odontoid cervical fractures have very low incidence from all the cervical fractures. In the vast majority, there is no neurological defect, or it is minimal, which is why its diagnosis is late.

Objective: To describe the clinical and radiological characteristics and the surgical treatment of a patient with type II odontoid fracture.

Case report: This is the case of a 49 years-old male patient, with a concomitant type II odontoid fracture, and a fracture of the anterior arch of the atlas, due to a fall from height. On physical examination, he had neck pain, paresthesia, and brachial diparesis. He underwent a conservative rigid orthosis treatment for eight weeks; pain and cervical contracture persisted. No signs of fusion were observed on radiological evaluation. Cervical traction and transaxial odontoid fixation were performed with single screw, without achieving a complete reduction; consequently, posterior fixation is completed using the modified Gallie technique.

Conclusions: Conservative treatment of type II odontoid fractures of more than 6 millimeters of displacement results in fusion deficiency. Failure of the anterior approach to reduce focus increases the risk of nonunion. The modified Gallie technique guarantees adequate stabilization and fusion. The combination of both techniques results in excellent postoperative clinical and biomechanical evolution.