3 Type II Odontoid Fractures: Operative versus Nonoperative Management

2010 ◽  
Keyword(s):  
Nonoperative Management ◽  
Type Ii ◽  
Odontoid Fractures

NONOPERATIVE MANAGEMENT OF ODONTOID FRACTURES USING A HALOTHORACIC VEST

Neurosurgery ◽  
2007 ◽  
Vol 61 (3) ◽  
pp. 522-530 ◽  
Author(s):  
Patrick Platzer ◽  
Gerhild Thalhammer ◽  
Kambiz Sarahrudi ◽  
Florian Kovar ◽  
Gyoergy Vekszler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Fracture Healing ◽  
Nonoperative Management ◽  
Nonoperative Treatment ◽  
Activity Level ◽  
Long Term Results ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Appropriate Treatment

Abstract OBJECTIVE Despite various reports in the literature, the appropriate treatment of Type II odontoid fractures remains controversial. Although there is an increasing tendency toward surgical treatment of these fractures in recent years, nonoperative treatment strategies are still regarded as a practicable method, particularly in elderly patients with significant comorbidities. One purpose of this study was to determine the functional and radiographic long-term results after rigid immobilization of Type II odontoid fractures using a halothoracic vest. The second aim was to present a case-control series of patients with nonunion of Type II odontoid fractures compared with patients with successful fracture healing to determine specific risk factors for failure of halo immobilization. METHODS We reviewed the clinical and radiographic records of 90 patients with an average age of 69 years at the time of injury who had undergone nonoperative treatment of odontoid fractures using a halothoracic vest between 1988 and 2004. To identify potential risk factors for failure of halo fixation, patients were divided into “cases” and “controls.” Cases were defined as patients with nonfusion after halo immobilization, and controls were patients with successful fracture healing attained with this treatment option. RESULTS Seventy-five patients returned to their preinjury activity level and were satisfied with their treatment. The Smiley-Webster scale showed an overall functional outcome score of 1.64. Successful fracture healing was achieved in 76 patients (84%). In 14 patients, nonunion was diagnosed by standard x-rays and additional computed tomographic scans within 6 to 12 months after trauma. Referring to possible risk factors for failure of halo fixation, nonunion was found significantly more often in older patients and in those with displaced fractures of the odontoid. Secondary loss of reduction and delay of treatment were identified as further risk factors for nonfusion. CONCLUSION With regard to successful fracture healing and functional results of the patients, we had a satisfactory outcome after halo fixation of Type II odontoid fractures. Although a fusion rate of 84% should not be deemed as optimal, nonoperative management of these fractures using a halothoracic vest seems to be an appropriate treatment strategy in patients who are not suitable for surgical treatment.

Current controversies in nonoperative management of Type II odontoid fractures in the elderly

2014 ◽  
Vol 26 (3) ◽  
pp. 187-191
Author(s):  
Megan Carroll Paulus ◽  
Samuel Klatman ◽  
S. Babak Kalantar
Keyword(s):  
Nonoperative Management ◽  
The Elderly ◽  
Type Ii ◽  
Odontoid Fractures

Nonoperative Management of Type II Odontoid Fractures in the Elderly

Spine ◽  
2008 ◽  
Vol 33 (26) ◽  
pp. 2881-2886 ◽  
Author(s):  
Florentius Koech ◽  
Helen M. Ackland ◽  
Dinesh K. Varma ◽  
Owen D. Williamson ◽  
Gregory M. Malham
Keyword(s):  
Nonoperative Management ◽  
The Elderly ◽  
Type Ii ◽  
Odontoid Fractures

Operative versus nonoperative management of acute odontoid Type II fractures: a meta-analysis

2009 ◽  
Vol 11 (6) ◽  
pp. 651-658 ◽  
Author(s):  
Ali Nourbakhsh ◽  
Runhua Shi ◽  
Prasad Vannemreddy ◽  
Anil Nanda
Keyword(s):  
Nonoperative Management ◽  
Screw Fixation ◽  
Meta Analysis ◽  
Operative Management ◽  
Fusion Rate ◽  
Acute Type ◽  
Type Ii ◽  
Halo Vest ◽  
Odontoid Fractures ◽  
Fracture Displacement

Object The purpose of this study was to evaluate the feasibility of the criteria described in the literature as the indications for surgery for acute Type II odontoid fractures. Methods The authors searched the PubMed database for studies in which the fusion rate of acute Type II odontoid fractures following external immobilization (halo vest or collar) or surgery (posterior C1–2 fusion or anterior screw fixation) was reported. The only studies included reported the fusion rate for either 1) groups of patients whose age was either more or less than a certain age range (45–55 years); or 2) groups of patients with a fracture displacement of either more or less than a certain odontoid fracture displacement (4–6 mm) or the direction of displacement (see Methods section of text for more details). A meta-analysis in which the random effect model was used was conducted to analyze the data. Results There was a statistically significantly higher fusion rate for operative management compared with external immobilization (85 vs 60%, p = 0.01) for the patients > 45–55 years. However, the overall fusion rate was > 80% for the patients whose age was < 45–55 years, regardless of treatment modality, and no significant differences were observed between surgically and nonsurgically treated patients (89 and 81%, respectively; p = 0.29). The result of operation (overall fusion rate 89%) was superior to external immobilization (44%) when the fracture was posteriorly displaced (p < 0.001), but for anteriorly displaced fractures, the results of operative and nonoperative management were identical (p = 0.15). The overall fusion rate of operative management of both anteriorly and posteriorly displaced fractures proved to be > 85%, and no statistically significant difference was observed (p = 0.50). For all degrees of displacement (either > or < 4–6 mm) the operation proved to provide significantly better results than conservative treatment. The fusion rate of conservatively treated fractures with < 4–6 mm displacement was significantly better than in fractures with > 4–6 mm displacement (76 vs 41%, p = 0.002). Conclusions Operative treatment (posterior C1–2 fixation or anterior screw fixation) provides a better fusion rate than external immobilization for acute odontoid Type II fractures, although in certain situations, such as anterior displacement of the fracture and for younger (< 45–55 years of age) patients, conservative management (halo vest or collar immobilization) can be as effective as surgery. Operative management is recommended in older patients, in cases of posterior displacement of the fracture, and when there is displacement of > 4–6 mm.

scholarly journals Institutional review of the management of type II odontoid fractures: associations and outcomes with fibrous union

2021 ◽  
pp. 1-9
Author(s):  
Christopher Wilson ◽  
Mariana Hoyos ◽  
Andrew Huh ◽  
Blake Priddy ◽  
Stephen Avila ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Cerebrovascular Disease ◽  
Predictive Value ◽  
Nonoperative Management ◽  
Complication Rates ◽  
Type Ii ◽  
Predictive Values ◽  
Odontoid Fractures ◽  
Discharge Disposition

OBJECTIVEType II odontoid fractures may be managed operatively or nonoperatively. If managed with bracing, bony union may never occur despite stability. This phenomenon is termed fibrous union. The authors aimed to determine associations with stable fibrous union and compare the morbidity of patients managed operatively and nonoperatively.METHODSThe authors performed a retrospective review of their spine trauma database for adults with type II odontoid fractures between 2015 and 2019. Two-sample t-tests and Fisher’s exact tests identified associations with follow-up stability and were used to compare operative and nonoperative outcomes. Sensitivity, specificity, and predictive values were calculated to validate initial stable upright cervical radiographs related to follow-up stability.RESULTSAmong 88 patients, 10% received upfront surgical fixation, and 90% were managed nonoperatively, of whom 22% had fracture instability on follow-up. Associations with instability after nonoperative management include myelopathy (OR 0.04, 95% CI 0.0–0.92), cerebrovascular disease (OR 0.23, 95% CI 0.06–1.0), and dens displacement ≥ 2 mm (OR 0.29, 95% CI 0.07–1.0). Advanced age was not associated with follow-up instability. Initial stability on upright radiographs was associated with stability on follow-up (OR 4.29, 95% CI 1.0–18) with excellent sensitivity and positive predictive value (sensitivity 89%, specificity 35%, positive predictive value 83%, and negative predictive value 46%). The overall complication rate and respiratory failure requiring ventilation on individual complication analysis were more common in operatively managed patients (33% vs 3%, respectively; p = 0.007), even though they were generally younger and healthier than those managed nonoperatively. Operative or nonoperative management conferred no difference in length of hospital or ICU stay, discharge disposition, or mortality.CONCLUSIONSThe authors delineate the validity of upright cervical radiographs on presentation in association with follow-up stability in type II odontoid fractures. In their experience, factors associated with instability included cervical myelopathy, cerebrovascular disease, and fracture displacement but not increased age. Operatively managed patients had higher complication rates than those managed without surgery. Fibrous union, which can occur with nonoperative management, provided adequate stability.

Surgical Treatment of Unstable Type II Odontoid Fractures in Skeletally Mature Individuals

Spine ◽  
2010 ◽  
Vol 35 (Supplement) ◽  
pp. S209-S218 ◽  
Author(s):  
Alpesh A. Patel ◽  
Ron Lindsey ◽  
Jason T. Bessey ◽  
Jens Chapman ◽  
Raja Rampersaud
Keyword(s):  
Surgical Treatment ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Unstable Type

scholarly journals Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population

Medicine ◽  
2019 ◽  
Vol 98 (44) ◽  
pp. e10281 ◽  
Author(s):  
Lei Fan ◽  
Dingqiang Ou ◽  
Xuna Huang ◽  
Mao Pang ◽  
Xiu-Xing Chen ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Type Ii ◽  
Geriatric Population ◽  
Odontoid Fractures

Anterior fixation of odontoid fractures in an elderly population

2010 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Andrew T. Dailey ◽  
David Hart ◽  
Michael A. Finn ◽  
Meic H. Schmidt ◽  
Ronald I. Apfelbaum
Keyword(s):  
Elderly Population ◽  
Odontoid Process ◽  
Feeding Tube ◽  
Type Ii ◽  
Single Institution ◽  
Odontoid Fractures ◽  
Single Screw ◽  
Flexion Extension ◽  
Fracture Nonunion

Object Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.

Sign in / Sign up

Export Citation Format

Share Document