Vertically Unstable Type III Odontoid Fractures

✓ Odontoid fractures are a common traumatic upper cervical spine injury. Treatment of Type III odontoid fractures includes skeletal traction for realignment and halo vest immobilization. The authors report an unusual case of severe atlantoaxial ligamentous disruption accompanying a traumatic Type III odontoid fracture. Five pounds of skeletal traction was associated with marked neurological deterioration from unanticipated longitudinal instability. Radiographic findings were identified that were suggestive of extensive ligamentous disruption. Recommendations for individualized patient management are given in the context of related literature.

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P82. Long-term Outcome of Anterior Screw Stabilization for Surgical Management of Type II and Rostral Type III Acute Odontoid Fractures

The Spine Journal ◽

10.1016/j.spinee.2006.06.228 ◽

2006 ◽

Vol 6 (5) ◽

pp. 122S ◽

Cited By ~ 1

Author(s):

Kostas Fountas ◽

Eftychia Kapsalaki ◽

Leonidas Nikolakakos ◽

Theofilos Machinis ◽

Arthur Grigorian ◽

...

Keyword(s):

Surgical Management ◽

Type Ii ◽

Term Outcome ◽

Long Term Outcome ◽

Odontoid Fractures ◽

Type Iii

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Chronic hypertrophic malunion of C2 Fracture causing cervical quadriparesis; Case report and focused literature review

Surgical Neurology International ◽

10.25259/sni-251-2019 ◽

2019 ◽

Vol 10 ◽

pp. 107 ◽

Cited By ~ 1

Author(s):

Sanaullah Khan Bashir ◽

Syeda Maheen Batool ◽

Gohar Javed

Keyword(s):

Cervical Myelopathy ◽

Odontoid Fracture ◽

Type Ii ◽

Case Description ◽

Anterior Decompression ◽

Cervical Trauma ◽

Spinal Stabilization ◽

Odontoid Fractures ◽

Unstable Type ◽

C2 Fracture

Background: Pseudarthrosis of Type II C2 odontoid fractures typically leads to displacement and subluxation resulting in canal compression/cervical myelopathy. Case Description: Here, we present a 43-year-old male who sustained cervical trauma 28 years ago. He now presented with an acute 10-day onset of quadriparesis attributed to a chronic malunion of an unstable type II odontoid fracture. He successfully underwent a circumferential decompression and fusion (e.g., warranting a trans-oral odontoidectomy followed by C1-C3 posterior fusion). Conclusion: Progressive cervical myelopathy attributed to a chronic malunion of a type II odontoid fracture may require circumferential decompression/stabilization (e.g., an anterior decompression with osteophyte resection and posterior C1-C3 spinal stabilization).

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Surgical Treatment of Acute Type II and Rostral Type III Odontoid Fractures Managed by Anterior Screw Fixation

Southern Medical Journal ◽

10.1097/01.smj.0000177342.81752.74 ◽

2005 ◽

Vol 98 (9) ◽

pp. 895-900 ◽

Cited By ~ 5

Author(s):

Kostas N. Fountas ◽

Theofilos G. Machinis ◽

Eftychia Z. Kapsalaki ◽

Vassilios G. Dimopoulos ◽

Carlos H. Feltes ◽

...

Keyword(s):

Surgical Treatment ◽

Screw Fixation ◽

Acute Type ◽

Type Ii ◽

Odontoid Fractures ◽

Type Iii ◽

Anterior Screw Fixation

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Patterns of C-2 fracture in the elderly: comparison of etiology, treatment, and mortality among specific fracture types

Journal of Neurosurgery Spine ◽

10.3171/2017.3.spine161176 ◽

2017 ◽

Vol 27 (5) ◽

pp. 494-500 ◽

Cited By ~ 8

Author(s):

Ingrid Radovanovic ◽

Jennifer C. Urquhart ◽

Parham Rasoulinejad ◽

Kevin R. Gurr ◽

Fawaz Siddiqi ◽

...

Keyword(s):

Mortality Rate ◽

Mortality Rates ◽

Predisposing Factors ◽

Type I ◽

Type Ii ◽

Odontoid Fractures ◽

Type Iii ◽

Cord Injury ◽

Risk Factors For Falls ◽

Fracture Types

OBJECTIVEPrevious studies have focused on Type II odontoid fractures and have failed to report on the effect of other C-2 fracture types on treatment and outcome. The purpose of this study was to compare patient characteristics, cause of injury, predisposing factors to fracture, treatments, and mortality rates among C-2 fracture types in a cohort of elderly patients 70 years of age and older.METHODSA retrospective cohort study design was used. Patients who sustained a C-2 fracture between 2002 and 2011 and who were admitted to the authors’ Level 1 trauma center were identified using the Discharge Abstract Database and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S12.1. Fractures were classified as odontoid Type I, II, or III; hangman’s; C-2 complex (hangman’s appearance on sagittal images, Type III odontoid on coronal cuts); and other (miscellaneous). Age, sex, predisposing factors to falls, cause of injury, treatment, presence of autofusion in the subaxial cervical spine, and mortality rates were compared between fracture patterns.RESULTSOne hundred forty-one patients were included; their mean age was 82 years. Fractures included Type II odontoid (57%), complex (19%), Type III odontoid (11%), hangman’s (8%), and other (5%). Falls from a standing height accounted for 47% of injuries, and 65% of patients had ≥ 3 risk factors for falls. Subaxial autofusion was more common in odontoid fractures (p = 0.002). Treatment was mainly nonoperative (p < 0.0001). The 1-year mortality rate was 27%. Four patients died of spinal cord injury.CONCLUSIONSAlthough not as common as Type II odontoid fractures, other C-2 fractures including hangman’s, complex, and Type III odontoid fractures accounted for close to half of the injuries in the study cohort. There were few differences between the fracture types with respect to cause of injury, predisposing factors, or mortality rate. However, surgical treatment was more common for Type II odontoid fractures.

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Favorable prognosis with nonsurgical management of type III acute odontoid fractures: a consecutive series of 212 patients

The Spine Journal ◽

10.1016/j.spinee.2021.02.003 ◽

2021 ◽

Author(s):

Syed Ali Mujtaba Rizvi ◽

Eirik Helseth ◽

Mads Aarhus ◽

Marianne Efskind Harr ◽

Jalal Mirzamohammadi ◽

...

Keyword(s):

Consecutive Series ◽

Odontoid Fractures ◽

Type Iii ◽

Favorable Prognosis ◽

Nonsurgical Management

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Evidence-based analysis of odontoid fracture management

Neurosurgical FOCUS ◽

10.3171/foc.2000.8.6.2 ◽

2000 ◽

Vol 8 (6) ◽

pp. 1-6 ◽

Cited By ~ 103

Author(s):

Terrence D. Julien ◽

Bruce Frankel ◽

Vincent C. Traynelis ◽

Timothy C. Ryken

Keyword(s):

Selection Criteria ◽

Odontoid Fracture ◽

Evidence Based ◽

Type I ◽

Type Ii ◽

Fracture Type ◽

Class Iii ◽

Odontoid Fractures ◽

Type Iii ◽

Fracture Management

Object The management of odontoid fractures remains controversial. Evidence-based methodology was used to review the published data on odontoid fracture management to determine the state of the current practices reported in the literature. Methods The Medline literature (1966–1999) was searched using the keywords “odontoid,” “odontoid fracture,” and “cervical fracture” and graded using a four-tiered system. Those articles meeting selection criteria were divided in an attempt to formulate practice guidelines and standards or options for each fracture type. Evidentiary tables were constructed by treatment type. Ninety-five articles were reviewed. Five articles for Type I, 16 for Type II, and 14 for Type III odontoid fractures met selection criteria. All studies reviewed contained Class III data (American Medical Association data classification). Conclusions There is insufficient evidence to establish a standard or guideline for odontoid fracture management. Given the extent of Class III evidence and outcomes reported on Type I and Type III fractures, a well-designed case-controlled study would appear to provide sufficient evidence to establish a practice guideline, suggesting that cervical immobilization for 6 to 8 weeks is appropriate management. In cases of Type II fracture, analysis of the Class III evidence suggests that both operative and nonoperative management remain treatment options. A randomized trial or serial case-controlled studies will be required to establish either a guideline or treatment standard for this fracture type.

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