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Percutaneous Posterior Transarticular Atlantoaxial Fixation for the Treatment of Odontoid Fractures in the Elderly: A Prospective Study

Alhashash, Mohamed, MD∗,†; Shousha, Mootaz, MD∗,†; Gendy, Hany, BS; Barakat, Ahmed Samir, MD∗,‡; Boehm, Heinrich, MD

doi: 10.1097/BRS.0000000000002417

Study Design. A prospective study of 20 multimorbid patients older than 65 years undergoing minimally invasive surgical treatment for odontoid fracture.

Objective. To analyze the results of percutaneous transarticular atlantoaxial screw fixation as a new minimally invasive treatment modality in this high risk group of patients.

Summary of Background Data. Odontoid fractures are a common injury pattern in the elderly. These fractures typically present significant challenges as geriatric patients often have multiple comorbidities that may adversely affect fracture management. Despite numerous publications on this subject, with a trend toward primary operative stabilization, the appropriate treatment for this frequent and potentially life threatening injury remains controversial.

Methods. Between January 2013 and December 2015, 20 consecutive patients underwent posterior percutaneous transarticular atlantoaxial screw fixation for odontoid fracture type II. The two main inclusion criteria were age 65 years or older and ASA score of III or IV. The screws were inserted percutaneously with the help of two fluoroscopy devices. Clinical and radiological examinations were regularly performed for a minimum of 18 months postoperatively.

Results. The mean age was 81 years, all of them with multiple comorbidities. Reduction of the fracture and screw insertion was possible in all cases. The mean operative time was 51.75 minutes and mean blood loss was 41.7 mL. Three patients died in the first 3 months after surgery. Healing of the fracture occurred in 15 patients (88.2%). Revision surgery was not necessary in any of the patients. Mean visual analogue scale (VAS) at the final follow-up was 2.4, and mean patient satisfaction score was 7.1.

Conclusion. Percutaneous transarticular atlantoaxial fixation in elderly patients offers a good minimally invasive operative treatment in this multimorbid group of patients. This new technique with short operative time is well tolerated by the geriatric patients leading to a healing rate up to 88%.

Level of Evidence: 4

Department of Spine Surgery, Zentralklinik Bad Berka, Germany

Department of Orthopedic Surgery, Alexandria University, Egypt

Department of Orthopedic Surgery, Cairo University, Egypt.

Address correspondence and reprint requests to Mootaz Shousha, MD, Robert-Koch-Allee 9, 99437 Bad Berka, Germany; E-mail:

Received 15 June, 2017

Revised 22 August, 2017

Accepted 28 August, 2017

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: patents.

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