Technique of Distraction, Compression, Extension, Reduction to Reduce and Realign Old Displaced Odontoid Fracture From Posterior Approach: A Novel Technique

OBJECTIVE: Chronic ‘displaced’ displaced type II fractures, though uncommon, are difficult to manage. They usually require a transoral procedure followed by a posterior instrumented fusion. We describe here, a new method to reduce the fractured displaced odontoid using a posterior cervical approach only. METHODS: Prospective and observational, n=14 had a ‘displaced and irreducible’ old fracture dens causing cord compression (type I, 1; type II, 13). They underwent a novel technique to reduce the fracture. The C1 arch was first drilled and removed. The C1 lateral masses on both sides were then drilled completely and a spacer was placed between the occiput and C2 facet. Following this, an intraoperative reducing maneuver was performed, utilizing the spacer as a fulcrum, and then achieving complete reduction and realignment. RESULTS: All patients improved clinically (mean Nurick preoperative score: 4.07±0.8; the postoperative score was 1.3±0.4). The mean correction in effective canal diameter was 74.3%±9.5% and the mean correction in actual canal diameter was 77%±8.7%. Solid bone fusion was demonstrated in 12 patients with at least 1-year follow-up (follow-up range, 12–35 months; mean, 21.8±9.8 months). CONCLUSION: The new described modification of distraction, compression extension, and reduction seems to be effective for ‘displaced’ chronic fracture dens with cord compression. It avoids additional transoral surgery in these patients.