Minimally Invasive Surgery For Posterior Temporary Fixation Through Intermuscular Approach in the Treatment of Odontoid Fractures

Study design. Retrospective study. Objectives. This study aims to evaluate the effectiveness of temporary fixation through intermuscular approach in reducing intraoperative blood loss, postoperative pain, and preserving suboccipital musculature. Summary of Background Data. Odontoid fractures pose significant treatment challenges, particularly regarding the preservation of cervical range of motion and minimizing disruption to the occipitocervical muscles. Conventional posterior open approaches are associated with a high incidence of postoperative occipitocervical pain, dysfunction, and substantial perioperative blood loss. We hypothesized that minimally invasive posterior temporary fixation through an intermuscular approach, which avoids significant disruption of the suboccipital musculature, would offer advantages over the standard open approach. Methods. This study included patients aged less than 65 years old and without osteoporosis who underwent posterior temporary fixation for odontoid fractures between 2015 and 2023. Outcomes measured included fracture healing rate, surgery duration, blood loss, Visual Analog Scale (VAS) scores, narcotic use, postoperative complications, hospital stay duration, and changes in muscle cross-sectional area (CSA). Results. 45 patients were included (26 in the intermuscular group and 19 in the open group). No significant differences were found in fracture healing time or postoperative complications between the groups. The intermuscular group showed significantly lower intraoperative blood loss, shorter hospital stays, reduced postoperative VAS scores, and a decreased need for supplementary narcotics. Additionally, the intermuscular approach better preserved key occipitocervical muscles, with less CSA reduction compared to the open approach. No failures of internal fixation were observed in either group. Conclusion. Minimally invasive posterior temporary fixation through the intermuscular approach offers substantial benefits over traditional open surgery for odontoid fractures. These include reduced blood loss, lower postoperative pain, shorter recovery time, and better preservation of suboccipital musculature, all without compromising fracture healing. This technique provides an effective, muscle-sparing alternative for open temporary fixation in the treatment of odontoid fractures.