Endoscope-Assisted Anterior Odontoid Screw Fixation for Odontoid Fracture

Abstract

Objective

Odontoid fractures in older adults often lead to substantial morbidity and mortality. This study explores the outcomes of water-based endoscope-assisted anterior odontoid screw (AOS) fixation, a minimally invasive technique, in managing these fractures.

Methods

Six patients (5 men, 1 woman) underwent endoscope-assisted AOS fixation for displaced odontoid fractures. Surgical procedures and follow-up assessments were reviewed retrospectively. Inclusion criteria included type IIa or type IIb odontoid fractures with potential nonunion/instability.

Results

Surgical procedures demonstrated no intraoperative complications. The mean operation time was 82 minutes (69–107 minutes), with an average estimated blood loss of 28 mL (10–50 mL). Among the 5 patients followed for >6 months, 4 (80%) showed successful fusion through computed tomography. Screw-related complications were observed in 1 patient.

Conclusions

AOS fixation is advocated for managing unstable odontoid fractures and providing strength and fracture union rates without impending cervical motion. Incorporating minimally invasive approaches, particularly endoscopic techniques, has garnered interest. The novel endoscope-assisted AOS fixation method, unlike prior approaches, begins with endoscopic guidance and minimal incisions, potentially reducing the risk of neurovascular injury. This novel technique shows promise as an effective strategy for addressing unstable odontoid fractures.