Atlas and Odontoid Injury

Occasionally, odontoid fractures occur in conjunction with atlas injuries. Treatment with halo immobilization until C1 arch healing has occurred, followed by fusion with wiring of C1-C2 posterior elements, is one method of dealing with this combination of injury. If stabilization of the odontoid is critical to the care of the patient and halo immobilization is not practical, then anterior odontoid screw fixation is an appropriate method of fixation (Geisler et al. 1989). Alternatively, posterior transfacetal fixation of the C1-C2 facets, as described by Magerl, can be performed (Grob et al. 1991; Marcotte et al. 1993; Haid et al 2001; Figs. 11.26, 11.27). Loss of motion using odontoid screw fixation will be minimal, since no motion segments are fused. Transfacet screws will cause loss of rotation secondary to atlantoaxial immobilization.

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