Surgical management of odontoid fractures

The treatment of odontoid fractures is determined by multiple factors, including fracture type, presence of associated injuries, patient age, and patient comor-bidities. It is generally well accepted that type I and type III injuries heal well with non-operative treatment. However, some type I injuries can be seen in association with occipito-atlantal dislocation; and some type III fractures can be closer to the neck of the odontoid (high and shallow based), and may act like a type II fracture, that is, with an increased probability of nonunion. The treatment of type II fractures remains controversial. Over the past decade, internal fixation has become an accepted treatment for unstable injuries of the cervical spine. Multiple surgical approaches have been proposed. This article reviews the various alternatives for treating odontoid fractures, attempting to give to the reader a broad perspective on the current techniques, including information taken from evidence-based medicine.