# Low-cost Posterior C1–C2 Fusion Using Sublaminar Wiring in Neurologically Intact Young Patient with Type IIA Odontoid Fracture: A Resource-oriented Approach

## TL;DR

A low-cost surgical technique using sublaminar wiring is presented for treating a type IIA odontoid fracture in a young patient, suitable for low-resource settings.

## Contribution

The paper introduces a cost-effective posterior C1–C2 fusion method using sublaminar wiring for odontoid fractures in resource-limited environments.

## Key findings

- The sublaminar wiring technique successfully achieved fracture consolidation with no complications.
- The patient demonstrated excellent recovery and functional improvement post-surgery.
- The method is proposed as a viable alternative in areas lacking advanced spinal instrumentation.

## Abstract

To present a low-cost posterior cervical fixation technique using sublaminar wiring for the management of a comminuted odontoid fracture (type IIA) in a young, neurologically intact patient, emphasizing its relevance in low-resource environments where advanced instrumentation is inaccessible.

A 21-year-old male sustained a comminuted fracture of the odontoid process of C2 following a high-impact motorcycle accident. Upon admission, he was alert, fully oriented, and neurologically intact. Imaging revealed a comminuted type IIA odontoid fracture without displacement. Due to the patient's economic limitations and the unsuitability of the fracture for anterior fixation, a posterior approach using double sublaminar wiring between C1 and C2 with autologous iliac crest bone graft was performed.

The procedure was successfully completed with no intraoperative or postoperative complications. The patient was discharged on postoperative day 2 and demonstrated excellent recovery. Follow-up imaging at 3 months confirmed over 90% fracture consolidation. Imaging at 6 months was requested but not obtained due to loss of follow-up. Functional recovery was complete, with only a partial reduction in cervical range of motion as expected with C1–C2 fusion.

Sublaminar wiring offers a safe, effective, and affordable alternative for posterior fixation of comminuted odontoid fractures, particularly in young patients and in settings where access to advanced spinal instrumentation is limited.