{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T02:02:08Z","timestamp":1788832928507,"version":"build-2803163510"},"reference-count":76,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:p>Odontoid fractures comprise as many as 20% of all cervical spine fractures. Fractures at the dens base, classified by the Anderson and D\u2019Alonzo system as Type II injuries, are the most common pattern of all odontoid fractures and are also the most common cervical injuries in patients older than 70 years of age. Surgical treatment is recommended for patients older than 50 years with Type II odontoid fractures, as well as in patients at a high risk for nonunion. Anterior odontoid screw fixation (AOSF) and posterior cervical instrumented fusion (PCIF) are both well-accepted techniques for surgical treatment but with unique indications and contraindications as well as varied reported outcomes. In this paper, the authors review the literature about specific patients and fracture characteristics that may guide treatment toward one technique over the other.<\/jats:p>\n                  <jats:p>AOSF can preserve atlantoaxial motion, but requires a reduced odontoid, an intact transverse ligament, and a favorable fracture line to achieve adequate fracture compression. Additionally, older patients may have a higher rate of pseudarthrosis using this technique, as well as postoperative dysphagia. PCIF has a higher rate of fusion and is indicated in patients with severe atlantoaxial misalignment and with poor bone quality. PCIF allows direct open reduction of displaced fragments and can reduce any atlantoaxial subluxation. It is also used as a salvage procedure after failed AOSF. However, this technique results in loss of atlantoaxial motion, requires prone positioning, and demands a longer operative duration than AOSF, factors that can be a challenge in patients with severe medical conditions. Although both anterior and posterior approaches are acceptable, many clinical and radiological factors should be taken into account when choosing the best surgical approach. Surgeons must be prepared to perform both procedures to adequately treat these injuries.<\/jats:p>","DOI":"10.3171\/2015.1.focus14781","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T13:05:25Z","timestamp":1427893525000},"page":"E11","source":"Crossref","is-referenced-by-count":84,"title":["Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?"],"prefix":"10.3171","volume":"38","author":[{"given":"Andrei F.","family":"Joaquim","sequence":"first","affiliation":[{"name":"Department of Neurology, State University of Campinas (UNICAMP), S\u00e3o Paulo, Brazil; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alpesh A.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwestern University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"1065","article-title":"Fractures of the odontoid process. Treatment with anterior screw fixation","volume":"14","author":"Aebi","year":"1989"},{"key":"b2-focus14781","series-title":"Neurosurgery","first-page":"1145","article-title":"Treatment of remote type II axis fractures in the elderly: feasibility of anterior odontoid screw fixation","volume":"63","author":"Agrillo","year":"2008"},{"key":"b3-focus14781","series-title":"J Bone Joint Surg Am","first-page":"1663","article-title":"Fractures of the odontoid process of the axis","volume":"56","author":"Anderson","year":"1974"},{"issue":"2 Suppl","key":"b4-focus14781","series-title":"J Neurosurg","first-page":"227","article-title":"Direct anterior screw fixation for recent and remote odontoid fractures","volume":"93","author":"Apfelbaum","year":"2000"},{"key":"b5-focus14781","series-title":"Surg Neurol","first-page":"596","article-title":"Posterior C1-C2 transarticular screw fixation in the treatment of displaced type II odontoid fractures in the geriatric population\u2014review of seven cases","volume":"51","author":"Campanelli","year":"1999"},{"key":"b6-focus14781","series-title":"J Bone Joint Surg Am","first-page":"1340","article-title":"Fractures of the dens. A multi-center study","volume":"67","author":"Clark","year":"1985"},{"key":"b7-focus14781","series-title":"J Neurosurg Spine","first-page":"1","article-title":"Anterior fixation of odontoid fractures in an elderly population","volume":"12","author":"Dailey","year":"2010"},{"key":"b8-focus14781","series-title":"Clin Orthop Relat Res","first-page":"742","article-title":"The best surgical treatment for type II fractures of the dens is still controversial","volume":"469","author":"Denaro","year":"2011"},{"key":"b9-focus14781","series-title":"Neurosurgery","first-page":"306","article-title":"Experience in the management of odontoid process injuries: an analysis of 128 cases","volume":"18","author":"Dunn","year":"1986"},{"key":"b10-focus14781","series-title":"Am J Orthop","first-page":"410","article-title":"Treatment of displaced type II odontoid fractures in elderly patients","volume":"38","author":"Elgafy","year":"2009"},{"issue":"359","key":"b11-focus14781","series-title":"Clin Orthop Relat Res","first-page":"126","article-title":"Modified Gallie technique versus transarticular screw fixation in C1\u2013C2 fusion","author":"Farey","year":"1999"},{"key":"b12-focus14781","series-title":"Am J Surg","first-page":"495","article-title":"Fractures and dislocations of the cervical spine","volume":"46","author":"Gallie","year":"1939"},{"key":"b13-focus14781","series-title":"Acta Neurochir (Wien)","first-page":"47","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"Goel","year":"1994"},{"key":"b14-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"1843","article-title":"Acute axis fractures. Analysis of management and outcome in 340 consecutive cases","volume":"22","author":"Greene","year":"1997"},{"key":"b15-focus14781","series-title":"Neurosurgery","first-page":"281","article-title":"Axis fractures: a comprehensive review of management and treatment in 107 cases","volume":"17","author":"Hadley","year":"1985"},{"key":"b16-focus14781","series-title":"J Neurosurg","first-page":"32","article-title":"Odontoid fractures in elderly patients","volume":"78","author":"Hanigan","year":"1993"},{"key":"b17-focus14781","series-title":"J Bone Joint Surg Br","first-page":"472","article-title":"Fixation of odontoid fractures by an anterior screw","volume":"81","author":"Henry","year":"1999"},{"key":"b18-focus14781","series-title":"J Neurosurg","first-page":"366","article-title":"A clinical comparison of one- and two-screw odontoid fixation","volume":"89","author":"Jenkins","year":"1998"},{"key":"b19-focus14781","series-title":"Arq Neuropsiquiatr","first-page":"857","article-title":"Axis instrumentation: surgical results","volume":"70","author":"Joaquim","year":"2012"},{"key":"b20-focus14781","series-title":"World Neurosurg","first-page":"359","article-title":"Lateral mass screw fixation of the atlas: surgical technique and anatomy","volume":"74","author":"Joaquim","year":"2010"},{"issue":"3","key":"b21-focus14781","series-title":"Contemp Spine Surg","first-page":"1","article-title":"C1 and C2 spine trauma: evaluation, classification and treatment","volume":"11","author":"Joaquim","year":"2010"},{"issue":"4","key":"b22-focus14781","series-title":"Contemp Spine Surg","first-page":"1","article-title":"Occipito cervical trauma: evaluation, classification and treatment","volume":"11","author":"Joaquim","year":"2010"},{"key":"b23-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"2881","article-title":"Nonoperative management of type II odontoid fractures in the elderly","volume":"33","author":"Koech","year":"2008"},{"key":"b24-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"1234","article-title":"Management of type II dens fractures: a case-control study","volume":"25","author":"Lennarson","year":"2000"},{"key":"b25-focus14781","series-title":"Cervical Spine I","first-page":"322","article-title":"Stable posterior fusion of the atlas and axis by transarticular screw fixation","author":"Magerl","year":"1987"},{"key":"b26-focus14781","series-title":"J Trauma","first-page":"350","article-title":"Halo vest immobilization in the elderly: a death sentence?","volume":"59","author":"Majercik","year":"2005"},{"key":"b27-focus14781","series-title":"Turk Neurosurg","first-page":"583","article-title":"Clinical results of surgical management in type II odontoid fracture: a preliminary report","volume":"22","author":"Mashhadinezhad","year":"2012"},{"key":"b28-focus14781","series-title":"Eur Spine 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adults","volume":"72","author":"Ryken","year":"2013"},{"key":"b33-focus14781","series-title":"BMC Surg","first-page":"54","article-title":"Treatment modality in type II odontoid fractures defines the outcome in elderly patients","volume":"13","author":"Scheyerer","year":"2013"},{"key":"b34-focus14781","series-title":"J Spinal Disord Tech","first-page":"535","article-title":"Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study","volume":"21","author":"Smith","year":"2008"},{"key":"b35-focus14781","series-title":"Orthopedics","first-page":"650","article-title":"Trends in surgical management for type II odontoid fracture: 20 years of experience at a regional spinal cord injury center","volume":"31","author":"Smith","year":"2008"},{"key":"b36-focus14781","series-title":"J Trauma","first-page":"199","article-title":"Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures","volume":"60","author":"Tashjian","year":"2006"},{"key":"b37-focus14781","series-title":"Orthopedics","first-page":"1109","article-title":"Contemporary management of adult cervical odontoid fractures","volume":"23","author":"Vaccaro","year":"2000"},{"key":"b38-focus14781","series-title":"Clin Neurol Neurosurg","first-page":"185","article-title":"Age increases the risk of immediate postoperative dysphagia and pneumonia after odontoid screw fixation","volume":"126","author":"Vasudevan","year":"2014"},{"key":"b1-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"1065","article-title":"Fractures of the odontoid process. Treatment with anterior screw fixation","volume":"14","author":"Aebi","year":"1989"},{"key":"b2-focus14781","series-title":"Neurosurgery","first-page":"1145","article-title":"Treatment of remote type II axis fractures in the elderly: feasibility of anterior odontoid screw fixation","volume":"63","author":"Agrillo","year":"2008"},{"key":"b3-focus14781","series-title":"J Bone Joint Surg Am","first-page":"1663","article-title":"Fractures of the odontoid process of the axis","volume":"56","author":"Anderson","year":"1974"},{"issue":"2 Suppl","key":"b4-focus14781","series-title":"J Neurosurg","first-page":"227","article-title":"Direct anterior screw fixation for recent and remote odontoid fractures","volume":"93","author":"Apfelbaum","year":"2000"},{"key":"b5-focus14781","series-title":"Surg Neurol","first-page":"596","article-title":"Posterior C1-C2 transarticular screw fixation in the treatment of displaced type II odontoid fractures in the geriatric population\u2014review of seven cases","volume":"51","author":"Campanelli","year":"1999"},{"key":"b6-focus14781","series-title":"J Bone Joint Surg Am","first-page":"1340","article-title":"Fractures of the dens. A multi-center study","volume":"67","author":"Clark","year":"1985"},{"key":"b7-focus14781","series-title":"J Neurosurg Spine","first-page":"1","article-title":"Anterior fixation of odontoid fractures in an elderly population","volume":"12","author":"Dailey","year":"2010"},{"key":"b8-focus14781","series-title":"Clin Orthop Relat Res","first-page":"742","article-title":"The best surgical treatment for type II fractures of the dens is still controversial","volume":"469","author":"Denaro","year":"2011"},{"key":"b9-focus14781","series-title":"Neurosurgery","first-page":"306","article-title":"Experience in the management of odontoid process injuries: an analysis of 128 cases","volume":"18","author":"Dunn","year":"1986"},{"key":"b10-focus14781","series-title":"Am J Orthop","first-page":"410","article-title":"Treatment of displaced type II odontoid fractures in elderly patients","volume":"38","author":"Elgafy","year":"2009"},{"issue":"359","key":"b11-focus14781","series-title":"Clin Orthop Relat Res","first-page":"126","article-title":"Modified Gallie technique versus transarticular screw fixation in C1\u2013C2 fusion","author":"Farey","year":"1999"},{"key":"b12-focus14781","series-title":"Am J Surg","first-page":"495","article-title":"Fractures and dislocations of the cervical spine","volume":"46","author":"Gallie","year":"1939"},{"key":"b13-focus14781","series-title":"Acta Neurochir (Wien)","first-page":"47","article-title":"Plate and screw fixation for atlanto-axial subluxation","volume":"129","author":"Goel","year":"1994"},{"key":"b14-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"1843","article-title":"Acute axis fractures. Analysis of management and outcome in 340 consecutive cases","volume":"22","author":"Greene","year":"1997"},{"key":"b15-focus14781","series-title":"Neurosurgery","first-page":"281","article-title":"Axis fractures: a comprehensive review of management and treatment in 107 cases","volume":"17","author":"Hadley","year":"1985"},{"key":"b16-focus14781","series-title":"J Neurosurg","first-page":"32","article-title":"Odontoid fractures in elderly patients","volume":"78","author":"Hanigan","year":"1993"},{"key":"b17-focus14781","series-title":"J Bone Joint Surg Br","first-page":"472","article-title":"Fixation of odontoid fractures by an anterior screw","volume":"81","author":"Henry","year":"1999"},{"key":"b18-focus14781","series-title":"J Neurosurg","first-page":"366","article-title":"A clinical comparison of one- and two-screw odontoid fixation","volume":"89","author":"Jenkins","year":"1998"},{"key":"b19-focus14781","series-title":"Arq Neuropsiquiatr","first-page":"857","article-title":"Axis instrumentation: surgical results","volume":"70","author":"Joaquim","year":"2012"},{"key":"b20-focus14781","series-title":"World Neurosurg","first-page":"359","article-title":"Lateral mass screw fixation of the atlas: surgical technique and anatomy","volume":"74","author":"Joaquim","year":"2010"},{"issue":"3","key":"b21-focus14781","series-title":"Contemp Spine Surg","first-page":"1","article-title":"C1 and C2 spine trauma: evaluation, classification and treatment","volume":"11","author":"Joaquim","year":"2010"},{"issue":"4","key":"b22-focus14781","series-title":"Contemp Spine Surg","first-page":"1","article-title":"Occipito cervical trauma: evaluation, classification and treatment","volume":"11","author":"Joaquim","year":"2010"},{"key":"b23-focus14781","series-title":"Spine (Phila Pa 1976)","first-page":"2881","article-title":"Nonoperative management of type II odontoid fractures in the 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