Minimal invasive percutaneous C1C2 fixation using an intraoperative 3D imaging-based navigation system on management of odontoid fractures.

INTRODUCTION: Odontoid fractures are the most common lesions of the upper cervical spine in patients above 70 years-old. These fractures are associated with frequent co-morbidities and minimal invasive techniques might have the potential to reduce postoperative complications while ensuring a better precision. The aim of this study is to report an innovative technique and the preliminary results of minimally invasive atlantoaxial fixation using 3D intraoperative navigation system and percutaneous approach.

MATERIALS: Five consecutive patients diagnosed with an acute traumatic odontoid type II fracture and managed using a percutaneous Harms' fixation under 3D intraoperative navigation guidance were included in this retrospective study.

RESULTS: On the whole series, C1 lateral mass screws and C2 isthmus screws were successfully placed. In all the cases (100%), adequate screw positioning with no medial breach nor with transverse foramen obstruction was observed. No intraoperative complications such as injury of the vertebra artery, spinal nerve root, or spinal cord was reported in this series. None of the 5 patients received blood transfusion during or after the procedure. During the follow-up period (mean 11.2 months, range 5-16 months) 4 patients (80%) revealed a favorable clinical recovery and only 1 patient required occasional medication for moderate pain. The mean radiation exposure for each patient was 4.83 mSV and 0 mSv for surgical staff.

CONCLUSIONS: Minimally invasive atlantoaxial fixation using an intraoperative 3D navigation system is a safe and effective alternative to the conventional approach reducing post-operative morbidity.