scholarly journals Therapeutic management in an elderly patient with odontoid fracture

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.

SURGICAL MANAGEMENT OF ODONTOID FRACTURES, AN INSTITUTIONAL EXPERIENCE.

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.

scholarly journals Treatment of type II odontoid fracture in the elderly

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.

Microscopic Decompression of the Anterior Upper Cervical Spine: A Case of Odontoid Malunion to the Atlas

Neurosurgery ◽  
1984 ◽  
Vol 14 (5) ◽  
pp. 583-587 ◽  
Author(s):  
Jimmy Miller ◽  
Andrew D. Parent
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Odontoid Process ◽  
Transoral Approach ◽  
Upper Cervical Spine ◽  
Basilar Impression ◽  
Odontoid Fractures ◽  
Surgical Microscope ◽  
The Past ◽  
Upper Cervical

Abstract For the past 20 years, the transoral approach to the upper cervical spine has been utilized for odontoid fractures, the removal of an abnormal odontoid process, decompression of basilar impression, and biopsy or resection of nasopharyngeal or metastatic tumors. The effectiveness and safety of this procedure is well documented. Use of the surgical microscope adds to the efficiency and safety of the procedure. We are reporting a case of fusion of the odontoid base to the anterior arch of the atlas. To our knowledge, this entity has not been described previously. The spinal cord was protected by an initial posterior fusion of C-1, C-2, followed in 10 days by a tracheostomy and the transoral removal of the anterior C-1 arch and the abnormal dens. Because the medical history did not reveal a source of trauma, it is supposed that the patient had malunion of the odontoid process to C-2, with subsequent migration and fusion of the dens to the C-1 arch.

Delayed Neurological Deficit after Traumatic Odontoid Fracture

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Yesaya Yunus ◽  
Julius July ◽  
Lutfi Hendriansyah
Keyword(s):  
Neurological Deficit ◽  
Significant Risk ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Atlantoaxial Dislocation ◽  
Neurological Deficits ◽  
Odontoid Fractures ◽  
Neurological Improvement ◽  
Cord Injury ◽  
Cervical Traction

Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly.  If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy.We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation.Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients.All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture.

Delayed Neurological Deficit after Traumatic Odontoid Fracture

2018 ◽  
Vol 1 (2) ◽  
pp. 22
Author(s):  
Yesaya Yunus ◽  
Julius July
Keyword(s):  
Neurological Deficit ◽  
Significant Risk ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Atlantoaxial Dislocation ◽  
Neurological Deficits ◽  
Odontoid Fractures ◽  
Neurological Improvement ◽  
Cord Injury ◽  
Cervical Traction

Fractures of the odontoid process can lead to gross instability of the atlantoaxial complex and present a significant risk for a potentially catastrophic spinal cord injury. Type II odontoid fractures are the most common odontoid fractures and are unstable that may displace anteriorly or posteriorly.  If left untreated, the patient may develop atlantoaxial dislocation that causes neurological deficit also progressive myelopathy.We described the surgical management of four patients with a delayed neurological deficit after odontoid fracture with a history of trauma and after triggered by traditional massage. Traction several days before operation applied to achieve reduction of atlantoaxial dislocation.Posterior instrumentation and correction of atlantoaxial dislocation were performed with interarticular screw fixation (Harm technique) in all of the patients.All of the four patients showed a reduction of the atlantoaxial dislocation and also a neurological improvement. Cervical traction followed by posterior instrumented correction may be an effective alternative to treating delayed neurological deficits after traumatic odontoid fracture. 

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

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0260414
Author(s):  
Matthias K. Jung ◽  
Gregor V. R. von Ehrlich-Treuenstätt ◽  
Andreas L. Jung ◽  
Holger Keil ◽  
Paul A. Grützner ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Geriatric Patients ◽  
Odontoid Fracture ◽  
Cervical Collar ◽  
Type Ii ◽  
Lateral Bending ◽  
Odontoid Fractures ◽  
Human Cadavers ◽  
The Mean ◽  
External Stabilization

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.

scholarly journals Management of Odontoid Fractures in the Elderly: A Review of the Literature and an Evidence-Based Treatment Algorithm

Neurosurgery ◽  
2017 ◽  
Vol 82 (4) ◽  
pp. 419-430 ◽  
Author(s):  
Sravisht Iyer ◽  
R John Hurlbert ◽  
Todd J Albert
Keyword(s):  
Bone Health ◽  
Nonoperative Management ◽  
Management Strategies ◽  
Treatment Algorithm ◽  
The Elderly ◽  
Operative Management ◽  
Cervical Spine Fracture ◽  
Type I ◽  
Related Factors ◽  
Odontoid Fractures

Abstract Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Poor bone health and medical comorbidities contribute to increased surgical risk in this population; however, nonoperative management is associated with a risk of nonunion or fibrous union. We provide a review of the existing literature and discuss the classification and evaluation of odontoid fractures. The merits of operative vs nonoperative management, fibrous union, and the choice of operative approach in elderly patients are discussed. A treatment algorithm is presented based on the available literature. We believe that type I and type III odontoid fractures can be managed in a collar in most cases. Type II fractures with any additonal risk factors for nonunion (displacement, comminution, etc) should be considered for surgical management. However, the risks of surgery in an elderly population must be carefully considered on a case-by-case basis. In a frail elderly patient, a fibrous nonunion with close follow-up is an acceptable outcome. If operative management is chosen, a posterior approach is should be chosen when fracture- or patient-related factors make an anterior approach challenging. The high levels of morbidity and mortality associated with odontoid fractures should encourage all providers to pursue medical co-management and optimization of bone health following diagnosis.

scholarly journals Atraumatic Occult Odontoid Fracture in Patients with Osteoporosis-Associated Thoracic Kyphotic Deformity: Report of a Case and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Kanji Mori ◽  
Kazuya Nishizawa ◽  
Akira Nakamura ◽  
Shinji Imai
Keyword(s):  
Traumatic Event ◽  
Present Report ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Kyphotic Deformity ◽  
Diagnostic Challenge ◽  
Odontoid Fractures ◽  
Type Iii ◽  
Intensity Changes ◽  
Standard Radiographs

Anderson type II odontoid fractures are reported to be the most common injury of the odontoid process in patients over the age of 65. However, atraumatic occult Anderson type III odontoid fractures have been rarely described and remain a diagnostic challenge. In the present report, we illustrate a 78-year-old female with osteoporosis-associated marked thoracic kyphotic deformity who developed atraumatic Anderson type III occult odontoid fracture and raise awareness of this condition. Anteroposterior and lateral standard radiographs of cervical spine failed to disclose odontoid fracture. Magnetic resonance imaging demonstrated intensity changes of the axis. Subsequent computed tomography clearly demonstrated Anderson type III odontoid fracture. Conservative treatment achieved complete bone union without neurological deteriorations. At 3-year follow-up, the patient was doing well without neurological and radiological deteriorations. Even if the patients have no traumatic event, we have to keep odontoid fractures in our mind as one of the differential diagnoses when we encounter elderly patients with neck pain, especially in patients with osteoporosis-associated marked thoracic kyphotic deformity.

Diagnosis and Treatment of an Odontoid Fracture in a Patient with Polyostotic Fibrous Dysplasia: Case Report

Neurosurgery ◽  
1989 ◽  
Vol 24 (6) ◽  
pp. 905-909 ◽  
Author(s):  
Brett E. Stompro ◽  
John F. Alksne ◽  
Gary A. Press
Keyword(s):  
Case Report ◽  
Cervical Spine ◽  
Fibrous Dysplasia ◽  
Treatment Options ◽  
Odontoid Fracture ◽  
Diagnosis And Treatment ◽  
Alternative Methods ◽  
Polyostotic Fibrous Dysplasia ◽  
Odontoid Fractures

ABSTRACT Fibrous dysplasia of the cervical spine is rare. No prior reports have discussed odontoid fractures in the setting of fibrous dysplasia. We describe a 26-year-old man who suffered a traumatic odontoid fracture in an area of preexisting fibrous dysplasia. The patient was treated conservatively in a sterno-occipito-mandibular immobilizer brace with a good result. A review of fibrous dysplasia is presented. Alternative methods of diagnosis and treatment options in our patient are discussed.

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