Evaluation of external stabilization of type II odontoid fractures in geriatric patients—An experimental study on a newly developed cadaveric trauma model

Background Along with the growing geriatric population, the number of odontoid fractures is steadily increasing. However, the effectiveness of immobilizing geriatric odontoid fractures using a cervical collar has been questioned. The aim of the present study is to analyze the physiological and pathological motion in odontoid fractures and to assess limitation of motion in the cervical spine when applying a cervical collar. Methods Motion analysis was performed with wireless motion tracker on unfixed geriatric human cadavers. First, a new geriatric type II odontoid fracture model was developed. In this model, the type II odontoid fracture is operated via a transoral approach. The physiological and pathological flexion and lateral bending of the cervical spine resulting from this procedure was measured. The resulting motion after external stabilization using a cervical collar was analyzed. Results The new geriatric type II odontoid fracture model was successfully established using seven unfixed human cadavers. The pathological flexion of the cervical spine was significantly increased compared to the physiological flexion (p = 0.027). Furthermore, the flexion was significantly reduced when a cervical collar was applied. In case of flexion the mean remaining motion was significantly reduced (p = 0.0017) from 41° to 14°. For lateral bending the mean remaining motion was significantly reduced (p = 0.0137) from 48° to 18°. Conclusions In case of type II odontoid fracture, flexion and lateral bending of the cervical spine are increased due to spinal instability. Thus, if an odontoid fracture is suspected in geriatric patients, the application of a cervical collar should always be considered since external stabilization can significantly reduce flexion and lateral bending.

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Analysis of remaining motion using one innovative upper airway opening cervical collar and two traditional cervical collars

Scientific Reports ◽

10.1038/s41598-021-00194-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Matthias K. Jung ◽

Gregor V. R. von Ehrlich-Treuenstätt ◽

Holger Keil ◽

Paul A. Grützner ◽

Niko R. E. Schneider ◽

...

Keyword(s):

Cervical Spine ◽

Upper Airway ◽

Cervical Collar ◽

Lateral Bending ◽

Significant Difference ◽

Airway Opening ◽

Human Cadavers ◽

The Mean ◽

Immobilization Techniques

AbstractThe aim of this study was to compare the remaining motion of an immobilized cervical spine using an innovative cervical collar as well as two traditional cervical collars. The study was performed on eight fresh human cadavers. The cervical spine was immobilized with one innovative (Lubo Airway Collar) and two traditional cervical collars (Stifneck and Perfit ACE). The flexion and lateral bending of the cervical spine were measured using a wireless motion tracker (Xsens). With the Weinman Lubo Airway Collar attached, the mean remaining flexion was 20.0 ± 9.0°. The mean remaining flexion was lowest with the Laerdal Stifneck (13.1 ± 6.6°) or Ambu Perfit ACE (10.8 ± 5.8°) applied. Compared to that of the innovative Weinmann Lubo Airway Collar, the remaining cervical spine flexion was significantly decreased with the Ambu Perfit ACE. There was no significant difference in lateral bending between the three examined collars. The most effective immobilization of the cervical spine was achieved when traditional cervical collars were implemented. However, all tested cervical collars showed remaining motion of the cervical spine. Thus, alternative immobilization techniques should be considered.

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SURGICAL MANAGEMENT OF ODONTOID FRACTURES, AN INSTITUTIONAL EXPERIENCE.

10.36106/ijsr/5615871 ◽

2021 ◽

pp. 45-47

Author(s):

B.D. B.S. Naik ◽

M.V. Vijayasekhar ◽

P Prahaladhu ◽

K Satyavaraprasad ◽

Nikhil Tadwalkar

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

Odontoid Fracture ◽

Common Mechanism ◽

Type I ◽

Type Ii ◽

Odontoid Fractures ◽

Transoral Odontoidectomy ◽

King George Hospital ◽

A Prospective Study

Introduction- Odontoid fractures occur as a result of high impact trauma to the cervical spine. Hyperextension of the cervical spine is The most common mechanism of injury. Odontoid fractures occurs in 10 to 15% of all cervical spine fractures . Fracture of the odontoid process is classied into one of three types which are type I, type II, or type III fractures. Of all the types of odontoid fractures, type II is the most common and accounts for over 50% of all odontoid fractures . Materials and Methods- This is a prospective study conducted over 2 years in Neurosurgery Department, Andhra Medical College & King George Hospital, Visakhapatnam. Result: A total of 18 odontoid fractures were managed in the period of two years, out of which 2 were kept conservative and 16 were operated. Out of 16, 11were operated with odontoid screw and 2 underwent C1-C2 xation and 3 patients underwent Transoral Odontoidectomy with posterior occipito-cervical xation Conclusion: The treatment of odontoid fracture is complex and should be planned according to the type of odontoid fracture and neurological decit. Odontoid screw will sufce in patients with type II fracture with undisplaced fragments. Posterior C1-C2 xation is a better choice for complex odontoid fractures. Transoral odontoidectomy and occipito-cervical xation is reserved as the last option.

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Axis Fractures: A Comprehensive Review of Management and Treatment in 107 Cases

Neurosurgery ◽

10.1227/00006123-198508000-00006 ◽

1985 ◽

Vol 17 (2) ◽

pp. 281-290 ◽

Cited By ~ 163

Author(s):

Mark N. Hadley ◽

Carol Browner ◽

Volker K.H. Sonntag

Keyword(s):

Cervical Spine ◽

Cervical Vertebra ◽

Neurological Deficits ◽

Type Ii ◽

Halo Vest ◽

High Association ◽

Cervical Spine Injuries ◽

Odontoid Fractures ◽

Presenting Symptoms ◽

External Stabilization

Abstract The combination of movement, location, and anatomy of the axis predisposes it to multiple and varied fracture/dislocations distinct from other vertebrae. We examine all forms of axis fractures and address the appropriate treatment for each specific fracture type. In a retrospective review of 625 cervical spine fractures during an 8-year period, we found 107 axis fractures. There were 25 hangman's fractures (23%), 59 odontoid fractures (55%), and 23 miscellaneous fractures (22%), Each case was characterized by age, sex, the presence of associated injuries, presenting symptoms and findings, initial treatment, and results of that treatment. Excluding 6 early deaths, 90 of 101 patients were located for a median follow-up of 3.2 years. We found that 17% of cervical fractures involve the axis. Axis fractures have a high association with head and other cervical spine injuries, 40% and 18%, respectively. Few neurological deficits result from a fracture of the 2nd cervical vertebra. Hangman's fractures are effectively treated with external stabilization, preferably with a halo vest. We noted a shorter period of treatment using the halo vest as compared to the SOMI brace. Nonunion occurred in 26% of odontoid Type II fractures, but occurred in 67% of those with dens displacement of 6 mm or greater, regardless of age or direction of dislocation. We recommend early surgical therapy for this subgroup. There is no correlation between age and the rate of nonunion. In patients with odontoid Type II fractures with dens displacement of 0 to 5 mm, fusion occurs with external stabilization alone. Odontoid Type III fractures are one-half as common as Type II fractures, and all heal well with external stabilization. Twenty-two per cent of acute axis fractures are not hangman's or odontoid fractures. Miscellaneous fractures of the axis generally do well with external stabilization and immobilization.

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Cervical Spine Immobilization in Patients With a Geriatric Facial Structure: The Influence of a Geriatric Mandible Structure on the Immobilization Quality Using a Cervical Collar

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211021824 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110218

Author(s):

Matthias K. Jung ◽

Paul A. Grützner ◽

Niko R. E. Schneider ◽

Holger Keil ◽

Michael Kreinest

Keyword(s):

Cervical Spine ◽

Cervical Collar ◽

Structure Group ◽

Facial Structure ◽

Lateral Bending ◽

Mandibular Angle ◽

Emergency Medical Service Personnel ◽

Significant Difference ◽

Spine Motion ◽

The Mean

Introduction: Demographic changes have resulted in an increase in injuries among geriatric patients. For these patients, a rigid cervical collar is crucial for immobilizing the cervical spine. However, evidence suggests that patients with a geriatric facial structure require a different means of immobilization than patients with an adult facial structure. This study aimed to analyze the remaining motion of the immobilized cervical spine based on facial structure. Materials and Methods: This study was performed on 8 fresh human cadavers. Facial structure was evaluated via ascertaining the mandibular angle by computer tomography. A mandibular angle below 130°, belongs to the adult facial structure group ( n = 4) and a mandibular angle above 130°, belongs to the geriatric facial structure group ( n = 4). The flexion and lateral bending of the immobilized cervical spine were analyzed in both groups using a wireless motion tracker system. Results: A flexion of up to 19.0° was measured in the adult facial structure group. The mean flexion in the adult vs. geriatric facial structure groups were 14.5° vs. 6.5° (ranges: 9.0-19.0 vs. 5.0-7.0°), respectively. Thus, cervical spine motion was ( p = 0.0286) significantly more reduced in the adult facial structure group. No ( p = 0.0571) significant difference was oberserved in the mean lateral bending of the adult facial structure group (14.5°) compared to the geriatric facial structure group (7.5°). Conclusion: Emergency medical service personnel should therefore follow current guidelines and recommendations and perform cervical spine immobilization with a cervical collar, including in patients with a geriatric facial structure.

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Treatment of type II odontoid fracture in the elderly

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa235 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Preci Hamilton ◽

Peyton Lawrence ◽

Christian Valentin Eisenring

Keyword(s):

Screw Fixation ◽

Holistic Approach ◽

The Elderly ◽

Spinal Fracture ◽

Cannulated Screw ◽

Odontoid Fracture ◽

Zenker’S Diverticulum ◽

Type Ii ◽

Odontoid Fractures ◽

Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

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Type II Odontoid Fractures of the Cervical Spine

Spine ◽

10.1097/brs.0b013e3181e8e77c ◽

2011 ◽

Vol 36 (11) ◽

pp. 879-885 ◽

Cited By ~ 83

Author(s):

Andrew J. Schoenfeld ◽

Christopher M. Bono ◽

William M. Reichmann ◽

Natalie Warholic ◽

Kirkham B. Wood ◽

...

Keyword(s):

Cervical Spine ◽

Type Ii ◽

Odontoid Fractures

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Type II Odontoid Fractures Case Series: History of Seizures a Risk Factor for Failure of Non-operative Treatment of Type II Odontoid Fractures

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i10.2432 ◽

2021 ◽

Vol 11 (9) ◽

Author(s):

Matthew A. Prevost ◽

John G. DeVine ◽

Uzondu F. Agochukwu ◽

Jacob C. Rumley

Keyword(s):

Risk Factor ◽

Case Series ◽

Odontoid Fracture ◽

Type Ii ◽

Odontoid Fractures ◽

Non Union ◽

Fracture Displacement ◽

Increased Risk ◽

Cervical Orthosis ◽

History Of

Introduction:Odontoid fractures are one of the most common injuries to the cervical spine. Type II odontoid fracture treatment varies depending on age, co-morbidities, and fracture morphology. Treatment ranges from cervical orthosis to surgical intervention. Currently fractures with high non-union rates are considered for operative management which includes displacement of >6 mm, increasing age (>40-60 years), fracture gap >1 mm, delay in treatment >4 days, posterior re-displacement >2 mm, increased angulation, and history of smoking. While re-displacement of >2 mm has been associated with increased risk of non-union;, to the best of our knowledge, no studies have looked at the risk factors for re-displacement. Case Report:We present two 26-year-old male patients who were found to have minimally displaced type II odontoid fractures initially treated in a cervical collar. These two patients were subsequently found to have displaced their odontoid fracture after having a documented seizure. Conclusion:We suggest that a history of seizures be considered a risk factor for re-displacement of non-displaced type II odontoid fractures. Keywords:Operative indications odontoid case report, Type II odontoid fracture, Displacement, Seizure, Odontoid fracture displacement, Nondisplaced type ? odontoid fracture.

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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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Therapeutic management in an elderly patient with odontoid fracture

Aktualności Neurologiczne ◽

10.15557/an.2016.0026 ◽

2016 ◽

Vol 16 (4) ◽

pp. 201-207

Author(s):

Wojciech Ilków ◽

◽

Tomasz Krzeszowiec ◽

Dariusz Łątka ◽

◽

...

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

The Elderly ◽

Common Type ◽

Odontoid Fracture ◽

Therapeutic Management ◽

Cervical Spine Fracture ◽

Odontoid Fractures ◽

Regional Medical ◽

Comprehensive Discussion

Fracture of the odontoid process is the most common type of cervical spine fracture in elderly patients (i.e. population over the age of 70 years), which can lead to disability or death. The therapeutic management depends on imaging findings and patient’s general condition. The authors present a case of a 71-year-old patient diagnosed with odontoid fracture based on cervical spine computed tomography, who received surgical treatment in the Department of Neurosurgery of the Regional Medical Centre in Opole. The problem of odontoid fractures in the elderly has been a subject of a comprehensive discussion.

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Morphometric parameters of the odontoid process of C2 vertebrae, in Indian population, a CT evaluation

Surgical Neurology International ◽

10.25259/sni_417_2021 ◽

2021 ◽

Vol 12 ◽

pp. 494

Author(s):

Shankar Acharya ◽

Manoj Kumar ◽

Jay Deep Ghosh ◽

Nitin Adsul ◽

R. S. Chahal ◽

...

Keyword(s):

Indian Population ◽

Odontoid Process ◽

Morphometric Parameters ◽

Transverse Diameter ◽

Type Ii ◽

Normal Anatomy ◽

Odontoid Fractures ◽

Screw Insertion ◽

Ct Evaluation ◽

The Mean

Background: Osteosynthesis of odontoid fractures, especially for type II odontoid fractures, is often achieved by the placement of screws. Here, utilizing CT, we evaluated the normal anatomy of the odontoid process in an Indian population to determine whether one or two screws could be anatomically accommodated to achieve fixation. Methods: CT-based morphometric parameters of the odontoid process were assessed in 200 normal Indian patients (2018–2020). Results: Of 200 patients, 127 were male, and 73 were female. The mean minimum external transverse diameter (METD) was 8.80 mm (range 6.1–11.9 mm). Six (3%) patients had a minimum internal transverse diameter (TD) of >8.0 mm that would allow for the insertion of two 3.5-mm cortical screws without tapping, while 10 (5%) patients had TDs of <7.4 mm; none had diameters of <5.5 mm. The mean length of the implant was 36.45 mm in females and 36.89 mm in males, and the mean angle of screw insertion was 60.34° in females and 60.53° in males. Conclusion: About two-thirds (59%) of the 200 subjects in our study had a METD of <9 mm, indicating the impracticality for introducing second screws for odontoid fixation.

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