Comparison of Clinical Outcomes of Posterior C1-C2 Temporary Fixation Without Fusion and C1-C2 Fusion for Fresh Odontoid Fractures

Neurosurgery. 2016 Jan;78(1):77-83. doi: 10.1227/NEU.0000000000001006.


Background: Posterior C1-C2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. However, few studies analyze the difference in clinical outcome between this technique and posterior C1-C2 fusion technique for new odontoid fracture.

Objective: To verify whether the clinical outcome of the posterior C1-C2 temporary-fixation technique is superior to that of the posterior C1-C2 fusion technique in the treatment of a new odontoid fracture.

Methods: Twenty-one of 22 patients who underwent posterior C1-C2 temporary fixation of an odontoid fracture achieved fracture healing and regained motion of the atlantoaxial joint. The functional outcomes of these 21 patients were compared with that of a control group, which consisted of 21 randomly enrolled cases with posterior C1-C2 fixation and fusion. The differences between the 2 groups in the visual analog scale score for neck pain, neck stiffness, Neck Disability Index, 36-Item Short Form Health Survey, and time to fracture healing were analyzed.

Results: Significantly better outcomes were observed in the temporary-fixation group for visual analog scale score for neck pain, Neck Disability Index, and neck stiffness. The outcomes in the temporary-fixation group was superior to those in the fusion group in all dimensions of the 36-Item Short Form Health Survey. There were no significant differences in fracture healing rate and time to fracture healing between the 2 techniques.

Conclusion: Functional outcomes were significantly better after posterior C1-C2 temporary fixation than after fusion. Temporary fixation can be used as a salvage treatment for an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Cervical Vertebrae / diagnostic imaging
  • Cervical Vertebrae / injuries
  • Cervical Vertebrae / surgery
  • Female
  • Fracture Fixation / methods
  • Fracture Fixation / trends*
  • Fracture Healing
  • Humans
  • Male
  • Middle Aged
  • Neck Pain / diagnostic imaging
  • Neck Pain / surgery
  • Odontoid Process / diagnostic imaging*
  • Odontoid Process / injuries
  • Odontoid Process / surgery*
  • Radiography
  • Range of Motion, Articular
  • Retrospective Studies
  • Salvage Therapy / methods
  • Spinal Fractures / diagnostic imaging*
  • Spinal Fractures / surgery*
  • Spinal Fusion / methods
  • Spinal Fusion / trends*
  • Treatment Outcome
  • Young Adult