Treatment of Odontoid Process Pathologic Fracture with Anterior Odontoid Screw Fixation and Vertebroplasty: Technical Case Report

Background: Odontoid process fractures are not uncommon in patients with metastatic cancer. They occur most often with lytic lesions originating from the lung, breast, prostate, myeloma or lymphoma1. Pathologic fractures can lead to progressive subluxation and compression of the spinal cord. However, there is no consensus regarding appropriate treatment for these severely ill cancer patients. External immobilization, radiotherapy, percutaneous vertebroplasty, and posterior fixation have been proposed, alone or in combination. However, very few authors consider anterior odontoid screw fixation combined with open vertebroplasty in the management of this condition.

Methods: We report a case of a 74-year-old male, known for a metastatic lung adenocarcinoma with superior vena cava syndrome (SVCS), who presented with a pathologic C2 fracture without significant trauma. There was no neurological deficit, but severe cervical pain. CT-scan showed a pathologic fracture of C2, with a lytic lesion and anterior displacement of the odontoid process. Because of instability, pain, risk for neurological impairment, and relative contraindication for prone positioning, an anterior odontoid screw fixation, along with vertebroplasty, was performed.

Results: A right anterior cervicotomy was performed. Under fluoroscopy, two canulated odontoid screws were placed in the distal fragment, and followed by cement vertebroplasty in the lytic lesion. There was no leakage of cement or complication. Post-operative CT-scan and clinical course were satisfactory. The patient was discharged home a few days later. Three months after surgery, he showed a nearly normal head range of motion.

Conclusion: We present a case of an odontoid process pathologic fracture treated with anterior odontoid fixation and vertebroplasty. We think that this treatment option is easy to perform under fluoroscopic guidance, combines two therapeutic modalities during the same surgery, restores head range of motion, and avoids prone positioning in severely ill metastatic cancer patients.