Salvatore Russo, Reza Mobasheri, Felipe de Negreiros Nanni, Khai Lam

June 2021, Volume 30, Issue 6, pp 1556 - 1565 Original Article Read Full Article 10.1007/s00586-021-06806-3

First Online: 18 March 2021


Odontoid process fractures can extend rostral into the C2 arch. We investigated the clinical impact of a concurrent fracture of the pars interarticularis on odontoid failure. To overcome the surgical challenges related to the morphology of these fractures, we describe a novel surgical strategy using atlantoaxial joint distraction arthrodesis.


We conducted a single centre cohort study of 13 consecutive patients with odontoid fractures extending into the pars treated between June 2016 and June 2018. Criteria for a stable fibrous non-union were: Atlanto-Dens Interval (ADI) < 3 mm, Posterior Atlanto-Dens Interval (PADI) > 14 mm and lack of symptomatic motion at the fracture site. Atlantoaxial instability was defined as greater than 50% subluxation across the C1-C2 joint. Return to pre-injury performance status was considered a satisfactory clinical outcome.


The mean age of the patient population was 77.2 years (SD 11.9). The mean follow-up time was 15 months (SD 5.2). 69% had an associated atlantoaxial instability (P-value 0.0005). Cervical orthosis treatment was associated with a high non-union rate (70%) (P-value 0.04) although it did not affect the overall clinical outcome. 2 cases presented with cord compression were treated surgically with pars interarticularis osteotomy and atlantoaxial distraction arthrodesis.


Odontoid fracture with extension into the pars interarticularis often present with atlantoaxial instability and may result in stable fibrous non-union if treated non-operatively. The C1–C2 segment can be stabilised with atlantoaxial distraction arthrodesis achieved through an osteotomy of the pars interarticularis.

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