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What Is Odontoid Screw Fixation?

Odontoid screw fixation is an anterior cervical procedure that stabilizes a fracture of the dens, or odontoid process, of the second cervical vertebra. It is used most often for selected acute type II odontoid fractures with a fracture pattern that can be reduced and compressed with a screw. A screw is passed from the front of C2 across the fracture and into the tip of the odontoid so the fragments heal together. Unlike posterior C1-C2 fusion, successful anterior fixation can preserve normal rotation between the first and second cervical vertebrae.

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What Is Odontoid Screw Fixation?

Odontoid screw fixation is an anterior cervical procedure that stabilizes a fracture of the dens, or odontoid process, of the second cervical vertebra. It is used most often for selected acute type II odontoid fractures with a fracture pattern that can be reduced and compressed with a screw. A screw is passed from the front of C2 across the fracture and into the tip of the odontoid so the fragments heal together. Unlike posterior C1-C2 fusion, successful anterior fixation can preserve normal rotation between the first and second cervical vertebrae.

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Why Is Odontoid Screw Fixation Performed?

The procedure is considered when an unstable odontoid fracture requires surgical stabilization and the anatomy is favorable for direct screw fixation. Ideal candidates generally have good bone quality, an intact transverse ligament, a reducible fracture, and a fracture line that allows compression across the dens. Severe osteoporosis, fracture comminution, inability to obtain reduction, transverse-ligament disruption, unfavorable fracture orientation, or major cervicothoracic deformity can make posterior fixation more appropriate. Recent reviews also note that nonunion risk after anterior fixation rises with factors such as advanced age, fracture gap, displacement, angulation, and delayed treatment.

How Is Odontoid Screw Fixation Performed?

The surgeon approaches the upper cervical spine through a small incision at the front of the neck while fluoroscopy or navigation confirms fracture alignment. A guidewire is advanced through the lower front portion of C2, across the fracture, and toward the tip of the dens. A lag screw is then placed along this path so tightening the screw compresses the fractured surfaces together. Final imaging confirms screw position, fracture reduction, and alignment before the incision is closed.

What Is Recovery Like After Odontoid Screw Fixation?

Patients are monitored after surgery for swallowing difficulty, airway problems, neurologic function, wound healing, and cervical alignment. A cervical collar can be used temporarily depending on fracture stability, bone quality, and surgeon preference. Activity is increased gradually while twisting, impact activity, and other movements that could stress the healing fracture are restricted. Follow-up computed tomography or X-rays are used to assess fracture union and confirm that the screw remains in a stable position.

What Are the Risks and Complications?

Possible complications include infection, bleeding, dysphagia, airway swelling, nerve injury, and problems related to the anterior neck approach. The screw can be misplaced, loosen, back out, or fail to compress the fracture adequately. Nonunion or pseudarthrosis can occur, particularly in patients with poor bone quality or unfavorable fracture characteristics, and can require posterior C1-C2 fusion. Rare but serious complications include spinal-cord injury, vascular injury, esophageal injury, or neurologic deterioration.

Frequently Asked Questions About Odontoid Screw Fixation

What fracture is treated with odontoid screw fixation?

The procedure is used mainly for selected unstable type II odontoid fractures with a reducible fracture pattern and suitable bone and ligament anatomy.

Does odontoid screw fixation preserve neck rotation?

Yes. One major advantage is preservation of C1-C2 motion, which contributes substantially to normal neck rotation, when the fracture heals successfully.

Who is not a good candidate for anterior odontoid screw fixation?

Severe osteoporosis, comminution, transverse-ligament injury, irreducible displacement, unfavorable fracture orientation, or difficult anterior access can favor a posterior fixation strategy.

Can odontoid screw fixation fail to heal?

Yes. Nonunion can occur and is more likely with poor bone quality, unfavorable fracture morphology, substantial displacement or gap, and some older patients.

References

Anterior Odontoid Screw Fixation: A Surgical Technique Guide By the Cervical Spine Research Society. PubMed. https://pubmed.ncbi.nlm.nih.gov/41554144/. Date Accessed September 11, 2026.

Anterior Odontoid Screw Fixation: Current Advances in Indications and Techniques. PubMed. https://pubmed.ncbi.nlm.nih.gov/42393451/. Date Accessed September 11, 2026.

Anterior screw fixation for odontoid fracture: clinical results in 45 cases. PubMed. https://pubmed.ncbi.nlm.nih.gov/20058455/. Date Accessed September 11, 2026.

Avoiding pitfalls in anterior screw fixation for type II odontoid fractures. PubMed. https://pubmed.ncbi.nlm.nih.gov/21961870/. Date Accessed September 11, 2026.

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion? PubMed. https://pubmed.ncbi.nlm.nih.gov/25828487/. Date Accessed September 11, 2026.