Treatment of Dens Fractures with Anterior Screw Fixation.

INTRODUCTION

Direct anterior screw fixation of the dens preserves C1-C2 rotation, and the reported fusion rates range from 88% to 100%.

STEP 1 POSITIONING OF THE PATIENT: Exact positioning of the patient and use of image intensifiers are mandatory to obtain perfect anteroposterior and lateral views of the axis.

STEP 2 SURGICAL APPROACH: The surgical approach is standardized, and the pretracheal layer can be exposed without violating any essential anatomic structures.

STEP 3 ENTRY POINT OF THE SCREW: The perfect entry point is directly anterior-inferior at the base of C2; therefore, the anterior rim of the C2-C3 intervertebral disc must be penetrated.

STEP 4 SCREW INSERTION: We use a single cannulated screw in most cases: insert the screw in the center of the dens with its tip perforating the cranial, cortical bone of the dens just posterior to the apex.

STEP 5 WOUND CLOSURE: Precise and anatomic closure of the platysma determines the quality of the scar that will be visible after the operation.

STEP 6 FOLLOW-UP: The patient wears a rigid collar for six weeks, removing it for body care; radiographic evaluations should be performed regularly.

RESULTS

In a study of sixty-nine patients with a fracture of the dens, three of the thirteen patients who underwent direct anterior screw fixation had persistent instability and nonunion of the dens four months after surgery. Indications Contraindications Pitfalls & Challenges.