Anatomy Atlas and Interpretation of Spine Surgery

28
J.-g. Shi et al.
Mandible
cephalad
Fig. 1.40 Exposure and incision of the anterior odontoid screw fixation
technique
Mandible
platysma
cephalad
alar ligament
apical
odontoid
ligament
odontoid process
vertebral
artery
Fig. 1.41 Platysma is lifted using the hemostatic forceps
4 Anterior Odontoid Screw Fixation
4.1 Overview
Fig. 1.38 Alar ligament and apical odontoid ligament
Fig. 1.39 Position and incision of anterior odontoid screw fixation
The Smith–Robinson approach is the most commonly used
method for exposing the middle cervical spine. It can expose
the anterior of the C3–T1 vertebrae and may directly expose
the intervertebral space and uncinated process in this
section.
Posterior atlantoaxial fusion has always been used to
treat unstable odontoid fractures. Despite the high fusion
rate, the posterior fusion surgery sacrifices the vertebral
movement of rotation, flexion, and extension. Bohler was
the first to use odontoid screw fixation in 1981. This
approach is suitable for patients with new and 3 months of
nonunion odontoid fractures of the type II and type III by
Anderson and D’ Alonzo. However, it is necessary to ensure
that the transverse ligament is not ruptured before using this
technique. The advantages of this technique are preservation
of the normal structure of the atlantoaxial joint, maximal
retention of vertebral rotation, flexion and extension,
and strong internal fixation that provides immediate stability
to the fracture. Moreover, this approach is minimally