• Mauro Dobran, Davide Nasi, Domenico Paolo Esposito, and Maurizio Iacoangeli.
• Department of Neurosurgery, Università Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy.
• World Neurosurg. 2016 Sep 1.

ObjectiveTo evaluate the long term C1-C2 fusion rates, fracture healing and functional outcomes in geriatric patients with type II odontoid fracture treated with posterior fixation with polyaxial C1 lateral mass screws and C2 pars screws.MethodsTwenty-one consecutive patients between 2005 and 2011 with Anderson and D'Alonzo type II odontoid fracture underwent a posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. A long-term clinical and radiological follow-up was achieved in all patients with a mean follow-up period of 53.28 ± 15.41 months (range 38-91 months).ResultsAll 21 patients had bilateral C1 lateral mass screws and bilateral C2 pars screws. Correct positioning of the C1 lateral mass screws and C2 pars screws was observed in all 42 placements by postoperative CT-scans. No vascular or neurological complication was noted. At the last follow-up, 20 patients (95.24 %) had a solid fusion (defined as Lenke fusion grade of A or B) while 1 patient (4.76 %) had a partial fusion (Lenke fusion grade of C). Overall no hardware failures occurred in any patient. Odontoid fracture healing was achieved in 18 patients out of 21 (85.71 %). The mean postoperative neck disability index (NDI) score was 12.73 % and neck motion was within normal physiologic limits at 12 months.ConclusionsThis study adds to the evidence that posterior atlantoaxial fixation with polyaxial C1 lateral mass screws and C2 pars screws is a safe and effective surgical option in the treatment of odontoid fractures including long-term stability.Copyright © 2016 Elsevier Inc. All rights reserved.

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