Use of C1 Lateral Mass and C2 Intralaminar Fixation to Stabilize a 30-Year-Old Odontoid Fracture That Was Causing Myelopathy

Abstract not available. Introduction provided instead.

Odontoid fractures occur with a bimodal incidence. They are usually seen after a fall in the elderly or a motor vehicle accident in the young.^1,2 Their sensitive location and potential to destabilize the craniocervical junction can result in neurologic compression. Despite extensive discussions in the literature regarding the epidemiology, imaging, and classifications of odontoid fractures, there has been no consensus on the best treatment options for the type II fracture across various age groups.^3-5

In this article, we present the case of a patient in whom myelopathy developed more than 30 years after he sustained a type II odontoid fracture in a motor vehicle accident. This case is unique for 2 reasons. First, the prolonged asymptomatic period between initial injury and symptom onset is rare.^6-8 Second, the surgical technique used was a unique modification of prior C1–C2 fixation techniques.

C1 lateral mass fixation was initially described by Goel and Laheri⁹ in 1994 and then popularized by Harms and Melcher¹⁰ in 2001. Initially, C1 fixation was paired with C2 pars (pedicle) fixation. However, up to 20% of patients may have vertebral artery anatomy that precludes safe C2 pedicular fixation.¹¹ In 2004, Wright¹² described intralaminar fixation of C2 as a potential solution for patients with medialized vertebral arteries that make C2 pedicle screw placement dangerous.

The present case of late myelopathy caused by odontoid nonunion was successfully treated with instrumentation and fusion using C1 lateral mass and C2 intralaminar fixation.