Computer-assisted navigation of anterior odontoid screw fixation for type II odontoid fracture: case report and practical positioning technique

Background: Odontoid process fractures, particularly type 2 fractures, pose significant treatment challenges due to their high rates of nonunion. Anterior odontoid screw fixation (AOSF) is traditionally performed using percutaneous methods with biplanar fluoroscopy. Computer-assisted navigation has emerged as a promising tool to enhance surgical precision, but its application in AOSF is rarely utilized. Cervical spine stability during AOSF is crucial for optimal outcomes and navigational accuracy.

Case description: A 64-year-old male presents with a displaced type 2 odontoid fracture following a fall. The fracture was treated with AOSF with the assistance of computed tomography (CT) navigation. A practical positioning technique employing a pressure infusion bag was introduced to stabilize cervical motion during surgery. This technique allows for precise instrumentation while minimizing the risk of navigational inaccuracy. Intraoperative imaging confirmed excellent fracture reduction and screw placement, facilitating a favorable surgical outcome.

Conclusions: CT navigation for AOSF is not yet widely adopted for the treatment of type 2 odontoid fractures due to inherent risks of fracture displacement, navigational inaccuracy, and iatrogenic injury. The off-label use of a pressure infusion bag for cervical stabilization offers a practical and cost-effective solution to enhance surgical precision. While further research is needed to compare the efficacy and radiation exposure of navigation-guided versus fluoroscopy-assisted AOSF, our report demonstrates that a safe and optimal outcome can be achieved using navigation-guided techniques.