X-ray exposure in odontoid screwing for Anderson type II fracture: comparison between O-arm and C-arm-assisted procedures

  • Luca RicciardiEmail author
  • Nicola Montano
  • Ginevra Federica D’Onofrio
  • Filippo Maria Polli
  • Marco Latini
  • Alessandro Bellesi
  • Fabio Biovi
  • Alessandro Olivi
  • Carmelo Lucio Sturiale
Technical Note - Spine trauma
Part of the following topical collections:
  1. Spine trauma



Since the odontoid fractures become increasingly common in the aging population, technical improvements are even more needed. The odontoid screwing has been progressively preferred by many surgeons in type II fractures according to the Anderson-D’Alonzo classification system. However, X-ray exposure remains an issue for surgeons and OR staff members. The aim of the present study was to investigate the feasibility of using the O-Arm for odontoid screwing comparing the radiation exposure to the standard C-Arm.


Patients consequently referred to our center for odontoid type II fractures, from January 2018 to April 2019, eligible for odontoid screwing were enrolled in the present study. They were operated on using either C-Arm or O-Arm-assisted procedures. The surgical duration, number of acquisitions, global X-ray exposure for the OR staff and patients, and screw placement accuracy were evaluated.


No differences in terms of patients’ demographical characteristics and surgical duration were reported. The number of acquisitions, intraoperative and global X-ray dose, for the OR staff and patients, was lower in O-Arm-assisted procedures (p < 0.05). The screws were all well positioned.


Since the surgical outcomes seem to be similar using the O-Arm for odontoid screwing, the lower X-ray exposure and the possibility for checking the instrumentation positioning with 3D reconstructions before leaving the OR should be considered.


Odontoid screwing CVJ X-ray exposure Patient’s safety Minimally invasive spine surgery Intraoperative imaging 



Anterior cervical approach for dens screwing




Cranio-vertebral junction




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Luca Ricciardi
    • 1
    • 2
    Email author
  • Nicola Montano
    • 1
  • Ginevra Federica D’Onofrio
    • 1
    • 2
  • Filippo Maria Polli
    • 1
  • Marco Latini
    • 3
  • Alessandro Bellesi
    • 3
  • Fabio Biovi
    • 3
  • Alessandro Olivi
    • 1
    • 2
  • Carmelo Lucio Sturiale
    • 1
  1. 1.UOC di NeurochirurgiaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly
  2. 2.Istituto di NeurochirurgiaUniversità Cattolica del Sacro CuoreRomeItaly
  3. 3.Dipartimento di RadiodiagnosticaFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly

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