ABSTRACT
Introduced in the early 1980s by J. Bohler and Nakinishi, anterior odontoid screw fixation represents one of only two indications for direct fracture repair in the cervical spine, the other being interfragmentary screw fixation of type II Hangman’s fractures. The success of odontoid screw fixation has been reported to be compromised in patients treated six months or more after injury. Technical considerations that may preclude the use of odontoid screw fixation involve the inability to obtain an appropriately cephalad screw trajectory along the sagittal longitudinal axis of the odontoid. Preoperative evaluation of patients being considered for anterior odontoid screw fixation should on whether the patient’s body habitus might preclude the use of this technique, and whether the patient has had a previous anterior cervical approach and may therefore require additional evaluation for possible pre-existing recurrent laryngeal nerve palsy.
