Percutaneous Image-Guided Anterior Screw Fixation of the Odontoid Process

Purpose To describe the technique of percutaneous image-guided anterior screw fixation of the odontoid process in five patients using hydrodissection of the jugulo-carotid and pre-vertebral spaces. Methods and Materials Between 03/2018 and 03/2020, five patients from two university hospitals underwent a percutaneous image-guided anterior screw fixation of the odontoid process for one pathological fracture, two impending fractures and two traumatic fractures of the dens. Technical success was defined as a satisfactory positioning of the screw in the odontoid. Detailed data with the number and type of needles required, the time to perform hydrodissection, the volume of fluid used, the time for bone access, the size and lengths of the screws used, technical success, complications, clinical outcomes and follow-up were retrospectively assessed. Results Technical success was achieved in 100% (5/5 cases), with a mean volume of hydrodissection of 218 +/- 8.4 mL (range 210-230). Mean total procedure time was 112 +/- 34 min (range 70-160). The lengths of the screws ranged from 30 mm to 55 mm. Additional cementoplasty was performed in the three malignant cases. VAS scores dropped on a 10-point scale from mean 5.8 +/- 2.2 pre-procedure to 0.8 +/- 0.4 after the procedure. No major complication occurred. Conclusion Percutaneous image-guided anterior screw fixation of the odontoid process using hydrodissection of the jugulo-carotid and pre-vertebral spaces is technically feasible and seems safe.