Technique A new transodontoid fixation technique for delayed type II odontoid fracture: technical note A. Fahir Ozer, MD a , Murat Cosar, MD b, ⁎ , Tunç B. Oktenoglu, MD a , Mehdi Sasani, MD a , A. Celal Iplikcioglu, MD c , Hakan Bozkus, MD, PhD a , Cengiz Bavbek, MD d , A. Cetin Sarioglu, MD a Departments of a Neurosurgery and d Radiology, VKV American Hospital, Istanbul, 34365 Turkey b Department of Neurosurgery, Faculty of Medicine, Carakkale 18 Mart University, 17200 Carakkale, Turkey c Department of Neurosurgery, Okmeydani Education Hospital, Istanbul, 39363 Turkey Received 5 August 2007; accepted 10 September 2007 Abstract Background: A different transodontoid screw fixation technique was studied in delayed type II odontoid fractures. This study presents observations on a different transodontoid fixation technique to remove and decrease the amount of sclerotic layers to accelerate the fusion process after the operation. Methods: Ten cases of chronic type II odontoid fractures were operated on via transodontoid screw fixation between 2000 and 2007 which were admitted 6 weeks or later after the trauma. Four of these 10 delayed patients were operated on using a new anterior transodontoid screw fixation technique, whereas the other 6 delayed patients were operated on using classical anterior transodontoid screw fixation. Results: Four delayed cases with type II odontoid fracture operated on via this new technique had good results throughout the minimum 38 months' follow-up period. We did not observe nonunion, infection, and/or other complications such as vascular or brain-stem injury. Conclusion: Transodontoid screw fixation should be considered as a preferable treatment modality. This surgical intervention may be an alternative to conservative treatment even for cases with delayed type II odontoid fractures. © 2009 Elsevier Inc. All rights reserved. Keywords: Cervical trauma; Odontoid screw fixation; Type II odontoid fracture 1. Introduction Sixty percent of all odontoid fractures are type II cases, forming a significant subgroup with a 6% mortality and morbidity rate [1,7,18]. As this group has a very small chance of spontaneous fusion with external immobilization, surgery is frequently the treatment of choice. Common treatment techniques include conservative halo immobilization and C1- C2 posterior wiring with surgical fusion. The new concept of transodontoid screw fixation is becoming one of the first choices of treatment for type II odontoid fractures. C1-C2 posterior screwing is another alternative technique which provides more rigid fixation than posterior wiring. Nonunion is one of the major problems of odontoid fractures. A review of the literature has demonstrated multiple factors influencing nonunion of type II odontoid fractures such as patients' age, extent of neurologic damage, degree of dense displacement, presence of concomitant C1-2 fracture, preexisting pathologic condition, and age of the fracture [6,19]. It is well known that chronic and/or delayed type II odontoid fracture has a relatively high nonunion rate Available online at www.sciencedirect.com Surgical Neurology 71 (2009) 121 – 125 www.surgicalneurology-online.com Abbreviation: CT, computed tomography. ⁎ Corresponding author. PK: 34 03000 Afyonkarahisar, Turkey. Tel.: +90 505 8041362; fax: + 90 272 2172029. E-mail address: drcosar@hotmail.com (M. Cosar). 0090-3019/$ – see front matter © 2009 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2007.09.027