title: Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients.
abstract: Objective:Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail  our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous  in clinical set ups lacking state of the art facilities.Methods and Results:In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study.Conclusion:Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing  patients in developing nations having rudimentary neurosurgical set up.
authors.affiliation: Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal.
authors.forename: Sunil
authors.initials: S
authors.lastname: Munakomi
authors.affiliation: Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal.
authors.forename: Karuna
authors.initials: K
authors.lastname: Tamrakar
authors.affiliation: Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Chaudhary
authors.affiliation: Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal.
authors.forename: Binod
authors.initials: B
authors.lastname: Bhattarai
keywords: Odontoid fracture; outcome; screw placement; technique