Odontoid fracture of the second cervical vertebra (C2) is the most common spinal fracture type in elderly patients. However, very little is known about the biomechanical fracture mechanisms, but could play a role in fracture prevention and treatment. This study aimed to investigate the biomechanical competence and fracture characteristics of the odontoid process. A total of 42 human C2 specimens (14 female and 28 male, 71.5 ± 6.5 years) were scanned via quantitative computed tomography, divided in 6 groups (n = 7) and subjected to combined quasi-static loading at a rate of 0.1 mm/s until fracturing at inclinations of −15°, 0° and 15° in sagittal plane, and −50° and 0° in transverse plane. Bone mineral density (BMD), specimen height, fusion state of the ossification centers, stiffness, yield load, ultimate load, and fracture type according to Anderson and d'Alonzo were assessed. While the lowest values for stiffness, yield, and ultimate load were observed at load inclination of 15° in sagittal plane, no statistically significant differences could be observed among the six groups (p = 0.235, p = 0.646, and p = 0.505, respectively). Evaluating specimens with only clearly distinguishable fusion of the ossification centers (n = 26) reveled even less differences among the groups for all mechanical parameters. BMD was positively correlated with yield load (R² = 0.350, p < 0.001), and ultimate load (R² = 0.955, p < 0.001), but not with stiffness (p = 0.070). Type III was the most common fracture type (23.5%). These biomechanical outcomes indicate that load direction plays a subordinate role in traumatic fractures of the odontoid process in contrast to BMD which is a strong determinant of stiffness and strength. Thus, odontoid fractures appear to result from an interaction between load magnitude and bone quality

Aims

Rates of mortality as high as 25% to 30% have been described following fractures of the odontoid in the elderly population. The aim of this study was to examine whether easily identifiable variables present on admission are associated with mortality.

Aims. We performed a retrospective, comparative study of elderly patients with an increased risk from anaesthesia who had undergone either anterior screw fixation (ASF) or halo vest immobilisation (HVI) for a type II odontoid fracture. Patients and Methods. A total of 80 patients aged 65 years or more who had undergone either ASF or HVI for a type II odontoid fracture between 1988 and 2013 were reviewed. There were 47 women and 33 men with a mean age of 73 (65 to 96; standard deviation 7). All had an American Society of Anesthesiologists score of 2 or more. Results. Patients who underwent ASF had a significantly better outcome than those who were treated by HVI. There was a rate of nonunion of 10% after ASF and 23% after HVI. Failure of reduction or fixation occurred in 11 patients (15%) but there was no significant difference between the two groups. Mortality rates were also similar: 9% (n = 3) after ASF and 8% (n = 4) after HVI. Conclusion. We conclude that ASF is the preferred method of treatment in this group of elderly patients, having a significantly higher rate of fusion, better clinical outcome and a similar rate of general and treatment-related complications. Cite this article: Bone Joint J 2016;98-B:1222–6

Fractures of the odontoid peg are common spinal injuries in the elderly. This study compares the survivorship of a cohort of elderly patients with an isolated fracture of the odontoid peg versus that of patients who have sustained a fracture of the hip or wrist. A six-year retrospective analysis was performed on all patients aged > 65 years who were admitted to our spinal unit with an isolated fracture of the odontoid peg. A Kaplan–Meier table was used to analyse survivorship from the date of fracture, which was compared with the survivorship of similar age-matched cohorts of 702 consecutive patients with a fracture of the hip and 221 consecutive patients with a fracture of the wrist. A total of 32 patients with an isolated odontoid fracture were identified. The rate of mortality was 37.5% (n = 12) at one year. The period of greatest mortality was within the first 12 weeks. Time made a lesser contribution from then to one year, and there was no impact of time on the rate of mortality thereafter. The rate of mortality at one year was 41.2% for male patients (7 of 17) compared with 33.3% for females (5 of 15). . The rate of mortality at one year was 32% (225 of 702) for patients with a fracture of the hip and 4% (9 of 221) for those with a fracture of the wrist. There was no statistically significant difference in the rate of mortality following a hip fracture and an odontoid peg fracture (p = 0.95). However, the survivorship of the wrist fracture group was much better than that of the odontoid peg fracture group (p < 0.001). Thus, a fracture of the odontoid peg in the elderly is not a benign injury and is associated with a high rate of mortality, especially in the first three months after the injury. Cite this article: Bone Joint J 2014;96-B:88–93

Transarticular screw fixation with autograft is an established procedure for the surgical treatment of atlantoaxial instability. Removal of the posterior arch of C1 may affect the rate of fusion. This study assessed the rate of atlantoaxial fusion using transarticular screws with or without removal of the posterior arch of C1. We reviewed 30 consecutive patients who underwent atlantoaxial fusion with a minimum follow-up of two years. In 25 patients (group A) the posterior arch of C1 was not excised (group A) and in five it was (group B). Fusion was assessed on static and dynamic radiographs. In selected patients CT imaging was also used to assess fusion and the position of the screws. There were 15 men and 15 women with a mean age of 51.2 years (23 to 77) and a mean follow-up of 7.7 years (2 to 11.6). Stable union with a solid fusion or a stable fibrous union was achieved in 29 patients (97%). In Group A, 20 patients (80%) achieved a solid fusion, four (16%) a stable fibrous union and one (4%) a nonunion. In Group B, stable union was achieved in all patients, three having a solid fusion and two a stable fibrous union. There was no statistically significant difference between the status of fusion in the two groups. Complications were noted in 12 patients (40%); these were mainly related to the screws, and included malpositioning and breakage. The presence of an intact or removed posterior arch of C1 did not affect the rate of fusion in patients with atlantoaxial instability undergoing C1/C2 fusion using transarticular screws and autograft.

Cite this article: Bone Joint J 2013;95-B:972–6.

Odontoid synchondral fractures are considered the most common type of fracture, amounting TO 10% of all subaxial injuries in the under 7 demographic. This injury occurs as typically the result of hyperflexion. Most odontoid fractures in children below 7 years of age involves the odontoid synchondrosis. The following is a report of the management of paediatric synchondral fractures in 2 patients who presented to the Children's Hospital Westmead in 2010. Both patients had displaced synchondral odontoid fractures which were managed by indirect reduction and halo traction. In both patients an anatomical alignment was achieved and maintained. Follow-up was 6 and 9 months respectively and the patients were assessed both clinically and radiologically. We feel the use of the “double mattress” technique is a valuable tool, as a means of achieving and maintaining occipitocervical extension, necessary, in the treatment of odontoid synchondral fractures

Existing techniques of posterior multi-point C1/2 stabilisation are technically demanding and can be hazardous. The coauthors have recently reported successful atlantoaxial fusion using a novel C1/2 stabilisation technique employing C1 multi-axial posterior arch screws (MA-PAS) in a clinical series of three patients where anatomical anomalies precluded established techniques. The technically less demanding nature of this new technique, and possible wider application in patients with normal anatomy, led the authors to investigate its biomechanical stability compared to other established techniques. Twenty-four human fresh-frozen cadaveric spines were harvested C0-C5. Motion was restricted to between C0 and C4. Each spine was non-destructively tested in flexion/extension, lateral bending and axial rotation, firstly in the intact state and then after Type 2 odontoid fracture destabilisation and insertion of Magerl-Gallie, Unicortical Harms, Bicortical Harms or MA-PAS instrumentation. ROM between C1 and C2 was monitored using two digital cameras. Results for each technique were compared statistically compared using ANOVA. The C1-C2 joint of the intact spines demonstrated high flexibility in flexion/extension (16.5deg). After instrumentation all specimens showed significantly reduced ROM in flexion/extension (Magerl-Gallie FE = 4.2deg, Unicort Harms FE = 7.2deg, Bicort Harms FE = 4.4deg). Lateral bend ROM of instrumented specimens (Magerl-Gallie LB =3.8deg, Unicort Harms LB = 3.8deg, Bicort Harms LB =2.3 deg) was, however, similar or slightly greater than intact (2.7 deg) . MA-PAS showed similar ROM in flexion/extension (4.2 deg) as the Magerl-Gallie and Harms techniques but was slightly higher in lateral bend (5.3 deg). The MA-PAS technique was shown to have similar biomechanical stability to the Magerl-Gallie and Harms techniques. Given the demonstrated biomechanical stability of the MA-PAS technique, it may be a suitable alternative to the existing technically demanding, and possibly more hazardous, multi-point fixation techniques in patients with normal, as well as anomalous, C1/2 segmental anatomy

Purpose of the study: Computed tomography is recommended for the preoperative work-up of joint fractures as it allows an optimisation of the access as a function of the injury. During the operation, 2D radiographic or fluoroscopic controls are still widely used. After one year’s experience, we evaluated the potential pertinence of using 3D reconstructions intraoperatively with a mobile isocentric fluoroscope (iso-C-3D). Material and methods: All operations for which the amplifier was used were collected prospectively. The type of fixation as well as the details of the installation and measures taken intraoperatively were noted. Results: At one year, intraoperative 3D reconstructions were made during 48 operations in 47 patients: fracture of the calcaneum (n=13), thoracolumbar spin (n=12), acetabulum (n=11), tibial condyles (n=9), odontoid (n=2), pelvis (n=1). The installation was habitual for the calcaneum and odontoid fractures. For the other localizations, use of a carbon plateau table facilitated good quality imaging for spinal and tibial condyle fractures; a carbon orthopaedic table was useful for acetabulum and pelvis fractures. With the intraoperative 3D reconstruction the surgeon was able to check the freedom of the canal after reduction and fixation. For the calcaneum fractures, reduction of the thalamic fragment was revised in one patient; in another, an intra-articular screw was replaced. One intra-articular screw stabilizing the posterior wall was also changed during an acetabulum fixation. Discussion: During our first year of use, 3D reconstruction intraoperatively has allowed us to avoid three early reoperations (for two calcaneums and one acetabulum). Classical 2D imaging of these two localizations is difficult to interpret because of the spherical form of the hip joint and, for the calcaneum, the difficulty in obtaining quality retrotibial images. Quality images requires specific installation, limiting interference with metallic supports. Conclusion: The results we have obtained in our first year of use of the ISO-C-3D amplifier has led us to generalise its use for percutaneous fixation procedures involving the acetabulum and the calcaneum

Purpose: Odontoid fractures are the most common cervical spine injuries in the elderly. Although octogenarians are the fastest growing age group, limited data exists on the natural history after they sustain odontoid fractures. Published mortality rates vary greatly, but are high enough to elicit comparisons to post-hip fracture mortality. It has also been suggested that halo-vest immobilization independently predicts mortality. Method: All traumatic odontoid fractures (type II or III) seen at our institution between 1996 and 2008 were identified and only patients who were ≥ 80 years of age were selected. A retrospective chart review was performed for injury characteristics, comorbidities, hospitalization details, treatment regimen and documented complications. Patients were stratified using the Charlson comorbidities index. The primary outcome was mortality at one year and was identified using a provincial database. Results: 72 cases were identified. Median age was 86 years (range 80 to 102). Patient treatment regimens included rigid neck collar, Halo vest orthosis, surgery or a combination thereof. 31% percent of the cohort (22 patients) was treated by Halo vest immobilization. Overall 1-year mortality rate was 15% (n=11) with only 1 Halo vest patient dying during this period. The majority of deaths (9 / 11) occurred in first 2 weeks following the injury. Conclusion: Mortality rate in the octogenarian population sustaining an odontoid fracture is high and approaches the 1-year hip fracture mortality rate. The utilization of a Halo vest was not associated with increased mortality rate in our study. Optimal treatment regimens, and strategies to minimize morbidity, particularly in the early post-injury phase, necessitate further study

Purpose: The current gold-standard for atlanto-axial fixation is C1-C2 Transarticular Screw (TS) fixation. In certain cases, the complicated nature of vertebral artery injury could make the application of bilateral transar-ticular screws impossible. This study biomechanically compares three atlantoaxial transarticular salvaging fixation techniques. Method: Nine Fresh ligamentous human cervical spine specimens (C0-C4) were thawed and the tissue surrounding the spine, except the ligaments and discs, was carefully removed. Pure moments were applied to skull in increments of 0.5 Nm from 0 Nm to 2.0 Nm with the help of loading arms, nylon strings and pulleys. The specimens were tested in extension (EXT), flexion (FLEX), left lateral bending (LB), right lateral bending (RB), left axial rotation (LR) and right axial rotation (RR) for all the cases. The positions of the LEDs were recorded using an Optotrak Motion Measurement System (Northern Digital, Waterloo, Ontario, Canada) and was converted into three rotations (flexion/extension, lateral bending and axial rotation) using rigid body kinematic principles in relation to the fixed base. The specimens were tested intact and after type II odontoid fracture, were instrumented and tested with three fixation constructs:. C1-C2 TS on right side and C1LMS-C2PS on contralateral side. C1-C2 TS on right side and C1LMS-C2IL on the contralateral side and. C1-C2 TS on right side with sublaminar wire. Results: All of the three instrumented cases significantly reduced motion across C1-C2 segment in all the modes when compared to intact (P< 0.005, two-tailed unpaired t-test at confidence interval of ninety-five percent) except in extension. TS+C1lM+C2PS is significantly stiffer than TS+ Wire only in axial rotation (P< 0.05) and equivalent in flexion/extension (P=0.75/P=0.51) and left/right bending (P=0.22/P=0.58). TS+C1LM +C2PS is equivalent to TS+C1LM+C2IL in all the loading modes (P> 0.05). TS+C1LM+C2IL is significantly stiffer than TS+Wire in axial rotation (P < 0.05) and equivalent in flexion/extension (P=0.93) and left/right bending (P=0.69/P=0.84). Conclusion: This study showed that TS+C1LMS+C2PS fixation is equivalent to TS+C1LMS+C2ILS fixation in all the rotation modes and superior to TS+Wire fixation in axial rotation averaged over all ranges of motion. Also, TS+C1LMS+C2ILS fixation is superior to TS+Wire fixation in axial rotation averaged over all ranges of motion

Introduction: The complex anatomy and biomechanics of the atlantoaxial motion segment impose technical challenges in the achievement of safe and successful surgical stabilization and fusion. The coauthors have recently reported successful clinical results using a novel C1-C2 stabilization technique employing C1 multi-axial posterior arch screws (MA-PAS). This study compares biomechanical stability of MA-PAS with two established multi-point fixation techniques (Magerl-Gallie and Harms) using non-destructive and destructive testing. Methods: 15 human fresh-frozen cadaveric occipital-C5 cervical spines (average age 77.4 [51–95], sourced from ScienceCare, USA) were randomly allocated to 3 equal groups. Screws were passed up through adjacent end vertebrae such that motion was limited to between C0 and C4. Each spinal column was non-destructively tested in flexion/extension (±1.5Nm), lateral bend (±1.5Nm) and axial rotation (±1.5Nm), firstly in their INTACT state and then after Type 2 odontoid fracture destabilization combined with MAGERL-GALLIE (n=5), HARMS (n=5) or MA-PAS (n=5) instrumentation. All 15 reconstructed spines were finally loaded to failure in forward flexion only. Results: Non-destructive testing: The C1-C2 joint of the INTACT spines all demonstrated high flexibility in flexion/ extension (ave 16.5deg) and axial rotation (ave 52.6 deg) while lateral bending (ave 2.7deg) was less compliant (see Fig.3). After instrumentation all specimens showed significantly reduced ROM in flexion/extension (MAGERL-GALLIE=4.2deg, HARMS=4.4deg, MA-PAS=4.2deg) and axial rotation (MAGERL-GALLIE=4.05deg, HARMS=0.59deg, MA-PAS=3.7deg) while lateral bend ROM of all instrumented specimens was similar or slightly greater than INTACT (HARMS=2.3deg, MAGERL-GALLIE=3.8deg, MA-PAS=5.3deg). There was no significant difference between the instrumented groups in each loading direction. Destructive testing: MAGERL-GALLIE was the strongest requiring an average of 13.5Nm to cause failure while HARMS was the weakest requiring 7.8Nm of torque. MA-PAS technique averaged 12.2Nm of torque to cause failure. Conclusions: The MA-PAS technique was shown to have similar ultimate strength in flexion to the MAGERL-GALLIE and HARMS techniques and stability in flexion-extension, axial rotation and lateral bend. The MA-PAS failure load in flexion was greater than the HARMS technique, and nearly as high as the MAGERL-GALLIE. Given the biomechanical stability of the MA-PAS technique, it is proposed that this technique is an alternative to the technically demanding, and possibly more hazardous, conventional multi-point fixation techniques in patients with normal, as well as anomalous, C1/2 segmental anatomy

There are many causes of paraspinal muscle weakness which give rise to the dropped-head syndrome. In the upper cervical spine the central portion of the spinal cord innervates the cervical paraspinal muscles. Dropped-head syndrome resulting from injury to the central spinal cord at this level has not previously been described. We report two patients who were treated acutely for this condition. Both presented with weakness in the upper limbs and paraspinal cervical musculature after a fracture of C2. Despite improvement in the strength of the upper limbs, the paraspinal muscle weakness persisted in both patients. One ultimately underwent cervicothoracic fusion to treat her dropped-head syndrome.

While the cause of the dropped-head syndrome cannot be definitively ascribed to the injuries to the spinal cord, this pattern is consistent with the known patho-anatomical mechanisms of both injury to the central spinal cord and dropped-head syndrome.

Fractures of the odontoid peg are relatively common in elderly people. Often they are minimally displaced and can be treated with a collar. However, a fracture which is displaced significantly may be difficult to manage. We describe the case of an 80-year-old man with a fracture of the odontoid peg which was completely displaced and caused respiratory distress. After initial closed reduction and application of a halo jacket, open and internal fixation was undertaken and relieved his symptoms. It is a safe and effective way to manage this injury.

We reviewed the outcome of a retrospective case series of eight patients with atlantoaxial instability who had been treated by percutaneous anterior transarticular screw fixation and grafting under image-intensifier guidance between December 2005 and June 2008.

The mean follow-up was 19 months (8 to 27). All eight patients had a solid C1–2 fusion. There were no breakages or displacement of screws. All the patients with pre-operative neck pain had immediate relief from their symptoms or considerable improvement. There were no major complications. Our preliminary clinical results suggest that percutaneous anterior transarticulation screw fixation is technically feasible, safe, useful and minimally invasive when using the appropriate instruments allied to intra-operative image intensification, and by selecting the correct puncture point, angle and depth of insertion.

Fractures of the odontoid in children with an open basilar synchondrosis differ from those which occur in older children and adults. We have reviewed the morphology of these fractures and present a classification system for them.

There were four distinct patterns of fracture (types IA to IC and type II) which were distinguished by the site of the fracture, the degree of displacement and the presence or absence of atlantoaxial dislocation. Children with a closed synchondrosis were classified using the system devised by Anderson and D’Alonzo. Those with an open synchondrosis had a comparatively lower incidence of traumatic brain injury, a higher rate of missed diagnosis and a shorter mean stay in hospital. Certain subtypes (type IA and type II) are likely to be missed on plain radiographs and therefore more advanced imaging is recommended. We suggest staged treatment with initial stabilisation in a Halo body jacket and early fusion for those with unstable injuries, severe displacement or neurological involvement.

Introduction: C1-2 polyaxial screw-rod fixation is a relatively new technique. While recognising the potential for inadvertent vertebral artery injury there have been few reports in the literature outlining all the possible complications. Aim:To review all cases of C1 lateral mass screw insertion with emphasis on the evaluation of the potential structures at risk during the procedure. Methods: We retrospectively reviewed all patients in our unit who has C1 lateral mass screw insertion over a 2 year period. The C1 lateral mass screw was inserted as part of an atlantoaxial stabilisation or incorporated into a modular occiput/subaxial construct. Outcome measures included clinical and radiological parameters. Clinical indicators included age, gender, neurologic status, surgical indication and the number of levels stabilised. Intraoperative complications including blood loss, vertebral artery injury or dural tears were recorded. Radiological indicators included post-operative plain radiographs to assess sagittal alignment and to check for screw malposition or construct failure. Results: A total of 18 C1 lateral mass screws were implanted in 9 patients. There were 3 male and 6 female patients who had C1 lateral mass screws inserted in this tertiary referral centre. Two patients had atlantoaxial stabilisation of a C2 odontoid fracture. There were 4 patients with rheumatoid arthritis whose C1 lateral mass screws were inserted as part of an occipitocervical or subaxial cervical stabilisation. The other pathologies included trauma and spinal tumours. There was no vertebral artery injury and no cerebrospinal fluid leak. Three patients developed post operative occipital neuralgia. This neuralgia was transient in one of the patients having settled at 6-week follow up. In the other 2 patients the neuralgia was unresolved at the time of latest follow up but was adequately controlled with appropriate pain management. Post operatively no patient had radiographic evidence of construct failure and all demostrated excellent sagittal alignment. Conclusion: It has been reported that the absence of threads on the upper portion of the long shank screw may protect against neural irritation. However insertion of the C1 lateral mass screw necessitates careful caudal retraction of the C2 dorsal root ganglion. The insertion point for the C1 lateral mass screw is at the junction of the C1 posterior arch and the midpoint of the posterior inferior part of the C1 lateral mass. Two patients in our series suffered occipital neuralgia post insertion of the C1 lateral mass screws. This highlights the potential for C2 nerve root irritation during and after the insertion of the C1 lateral mass screw

Fractures of the occipital condyle are rare. Their prompt diagnosis is crucial since there may be associated cranial nerve palsies and cervical spinal instability. The fracture is often not visible on a plain radiograph. We report the case of a 21-year-old man who sustained an occipital condylar fracture without any associated cranial nerve palsy or further injuries. We have also reviewed the literature on this type of injury, in order to assess the incidence, the mechanism and the association with head and cervical spinal injuries as well as classification systems, options for treatment and outcome.

Background: Type II odontoid fractures are the commonest upper cervical spine injury in the elderly, following minor falls. Structural heterogeneity within the axis with deficiency of bone mass in the base of the odontoid process has been attributed for these fractures. Aims: To analyse whether osteoporosis at the dens-body junction is directly related to the occurrence of odontoid fractures in the elderly. Material and Methods: We studied the reformatted CT scan images of 36 patients over the age of 70 years who had cervical spine injuries following minor trauma. In all these patients the severity of osteoporosis at the dens-body junction, and in the peg and body of axis were evaluated. The osteoporosis was graded into none, mild, moderate and severe. Statistical analysis was performed using Pearson’s Chi-square test to find the significance of osteoporosis at the dens-body junction in producing Type II odontoid fractures in the elderly. Results: Type II odontoid fractures was seen in 21 patients. Eleven of the 21 patients with Type II fractures and eight of the 15 patients with no Type II odontoid fractures had significant osteoporosis at the dens-body junction. Five patients with Type II fracture and eight patients with no Type II fractures had significant osteoporosis at the dens and body of axis. Statistical analysis showed that the osteoporosis at the dens-body junction was not significant in patients with Type II odontoid fracture compared to those with no Type II odontoid fracture (χ. 2. = 1.1; df = 3, p = 0.78). Conclusions: Eventhough osteoporosis is one of the factors that increase the incidence of Type II fractures of the odontoid process in the elderly, it is not a direct aetiological factor

Background: Type II odontoid fractures are the commonest upper cervical spine injury in the elderly, following minor falls. Structural heterogeneity within the axis with deficiency of bone mass in the base of the odontoid process has been attributed for these fractures. Aims: To analyse whether osteoporosis at the dens-body junction is directly related to the occurrence of odontoid fractures in the elderly. Material and Methods: We studied the reformatted CT scan images of 36 patients over the age of 70 years who had cervical spine injuries following minor trauma. In all these patients the severity of osteoporosis at the dens-body junction, and in the peg and body of axis were evaluated. The severity was graded into none, mild, moderate and severe, depending on the cortical thickness, trabecular pattern, and the size of holes (absence of trabeculae) using sagittal, coronal and transverse sections of CT scan pictures. The osteoporosis was graded into none, mild, moderate and severe. Statistical analysis was performed using Pearsons Chi-square test to find the significance of osteoporosis at the dens-body junction in producing Type II odontoid fractures in the elderly. Results: Type II odontoid fractures was seen in 21 patients. Eleven of the 21 patients with Type II fractures and eight of the 15 patients with no Type II odontoid fractures had significant osteoporosis at the dens-body junction. Five patients with Type II fracture and eight patients with no Type II fractures had significant osteoporosis at the dens and body of axis. Statistical analysis showed that the osteoporosis at the dens-body junction was not significant in patients with Type II odontoid fracture compared to those with no Type II odontoid fracture (Chi-square value = 1.1; df = 3, p = 0.78). Conclusions: Eventhough osteoporosis is one of the factors that increase the incidence of Type II fractures of the odontoid process in the elderly, it is not a direct aetiological factor

Objective: The purpose of this communication was to evaluate the long-term outcome of patients with type II odontoid fractures treated with anterior screw fixation. Material and Methods: In our prospective clinical study 34 patients, 21 males and 13 females (with mean age 35.4 + 0.8 years) with type II odontoid fractures of traumatic etiology, underwent anterior cannulated screw fixation, during a period of 36 months. All patients had radiologicaly confirmed intact transverse ligament and a reducible odontoid fracture. All patients were immobilized in a Miami J cervical collar for 4 weeks postoperatively. Radiological examination of the cervical spine with plain X rays and cervical spine CT was performed at 6 weeks and two, six and 12 and 24 months postoperatively. Follow-up time ranged between 36 and 80 months (mean follow-up 54.3+ months). Results: 32 patients had an uneventful postoperative course, while one patient developed pulmonary atelectasis, which resolved without any significant sequelae and another one developed a superficial wound infection, which resolved without removing the implanted hardware. Radiographic evaluation showed satisfactory bony fusion and no evidence of abnormal movement at the fracture site in 31 patients (91.1%). In two patients (5.8%), the radiographic studies showed pseudo-arthrosis and instability while in one patient (2.9%) the implanted cannulated screw was broken but there was no instability shown. Conclusions: In our series anterior odontoid screw fixation constituted a safe therapeutic modality with high stability and low mechanical failure rates in short and long term follow-up period