An Odontoid Screw/Standalone Anterior Cervical Interbody Cage Hybrid Can Stabilize a Combined C2 Fracture: A Technical Case Report

Objective: This operative case report describes the hybridization of an odontoid screw and standalone anterior cervical cage to stabilize concomitant odontoid and posterior element fractures of C2 in a single stage surgery. Background: There are a myriad of fracture patterns of the C2 vertebral body, which can occur in isolation or combination, and may complicate otherwise straightforward fixation strategies. So-called "type 3" displaced odontoid fractures with a coexisting posterior element fracture is one such scenario. The surgical treatment of these complex injuries may be optimized with innovative constructs. Case Presentation: A 30s-year-old male presented to our institution after a traumatic fall down stairs. They denied any preexisting or new neurologic deficit at the time of initial consultation. Imaging revealed a broad-based transverse fracture of the odontoid process of C2 with 6mm of anterior displacement and extension of the fracture line through the left pars interarticularis. The combination of these injuries was judged to warrant operative stabilization to prevent neurologic decline. Given the complex and likely unstable fracture pattern, patient’s age, and concern for neurologic function, a previously undescribed hybrid construct was conceived of and performed. A single odontoid screw was placed through the vertically oriented hole of a single level anterior cervical cage after C2/3 discectomy, thereby achieving fixation of the odontoid and vertebral motion segment simultaneously. Results: The operation was performed without complication. The patient had an uneventful recovery from surgery in a rigid cervical collar, and postoperative imaging demonstrated satisfactory hardware placement and early fusion of both fractures at two months. Conclusion: A previously undescribed technique of hybridizing a standalone anterior cervical cage with an odontoid screw was used to achieve simultaneous fixation of a combined odontoid and posterior element fracture pattern. This hybrid construct represents a novel surgical fixation strategy for these rare fractures.