Objective: Anterior single screw fixation is one of the surgical options providing sufficient
immediate stabilization of the spine and preserving normal C1-2 motion. In this study the
indications, the surgical technique, and outcome of patients who underwent this procedure
were reviewed. Methods: Thirty consecutive patients (25 males and 5 females) who
underwent anterior single screw fixation for recent Type II odontoid fractures at King Fahd
Hospital, Al-Madina Al-Munawarah, in Saudi Arabia (SA) between January 2004 and
December 2007 were included in this study. Data including clinical examination, imaging
studies and operative technique were used to analyze the results of this surgical technique.
Results: The clinical and radiological results, in our series, were conclusive. The use of
single screw for fixation of type II odontoid fracture was found easier and simpler than
common method at which the double screws were used with the same advantages. The
surgical technique resulted in immediate spinal stability and preserves normal rotation at
C1–2 in all patients (100% of cases). Radiological evidence of bone union achieved in 22
patients (73% of cases); and nonunion in 8 patients (27% of cases). Complications related to
surgical procedure and hardware failure were recorded in 4 patients (13% of cases).
Conclusions: Direct anterior single screw fixation is an effective, simple, and safe method for
treating type II odontoid fractures. It is associated with rapid patient mobilization, minimal
postoperative pain, and shorter hospital stay. By this technique, the required anatomical and
functional outcome can be obtained through immediate stability of the axis, preserves C1–2
rotatory motion, and achieved high union rate.