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. 

Vertical mobile and reducible atlantoaxial dislocation

2009 ◽  
Vol 11 (1) ◽  
pp. 9-14 ◽  
Author(s):  
Atul Goel ◽  
Abhidha Shah ◽  
Sanjay Rajan
Keyword(s):  
Facet Joint ◽  
Odontoid Process ◽  
Causative Factor ◽  
Basilar Invagination ◽  
Atlantoaxial Dislocation ◽  
Atlantoaxial Instability ◽  
Posterior Fixation ◽  
Neurological Improvement ◽  
Cervical Traction ◽  
King Edward Memorial Hospital

Object The authors' experience with treatment of 8 patients with “vertical mobile and reducible” atlantoaxial dislocation is reviewed. The probable pathogenesis, radiological and clinical features, and management issues in such cases are discussed. Methods Between January 2006 and March 2008, 8 patients who presented with vertical mobile and reducible atlantoaxial dislocations were treated at the Department of Neurosurgery at King Edward Memorial Hospital in Mumbai, India. The vertical atlantoaxial dislocation/basilar invagination reduced completely on extension of the neck, with no need of any cervical traction. According to the extent of superior migration of the odontoid process, and measurements based on the vertical atlantoaxial instability index, the dislocation was graded as mild, moderate, or severe. All patients were treated using the C-1 lateral mass and C-2 pars plate and screw method of fixation. Results The study group was composed of 5 male and 3 female patients (mean age 24 years, age range 8–54 years). All patients presented with the physical features of short neck, torticollis, pain in the nape of the neck, and varying degrees of quadriparesis. In 6 patients there was a history of trauma prior to the onset of major neurological symptoms. The dislocation was mild in 3 cases, moderate in 1, and severe in 4. All patients had clinical neurological improvement following surgery. The follow-up duration ranged from 4 to 30 months (mean 18 months). Conclusions Vertical mobile and reducible atlantoaxial dislocation is a discrete clinical entity. Abnormal inclination and incompetence of the facet joint appears to be the primary causative factor that resulted in vertical dislocation or basilar invagination. Posterior fixation in the reduced dislocation position forms the basis of treatment.

scholarly journals Proposal of a new method for treating type II odontoid fractures: Odontoid process prosthetic (Ti)

SURG Journal ◽  
2008 ◽  
Vol 1 (2) ◽  
pp. 49-56
Author(s):  
Marc Johnston ◽  
Shawn Ranieri ◽  
William De Wit
Keyword(s):  
Vertebral Body ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Neurological Deficits ◽  
Type Ii ◽  
Sintered Titanium ◽  
Implant Fixation ◽  
Odontoid Fractures ◽  
Non Union ◽  
Novel Method

A novel method for treating type II odontoid fractures is presented. The use of a sintered titanium odontoid prosthetic could eliminate long healing times associated with external fixation methods, and the neurological deficits associated with non-union events in odontoid fracture treatment. Finite element experiments provide early indications that the axis vertebral body could accommodate a titanium odontoid prosthetic. Strain of 3.5 % and stresses of up to 10.5 MPa on the reamed opening of the axis vertebral body are considered as the local maximums. Conventional and emerging implant fixation and non-fouling techniques are also discussed.

Odontoid Fracture

Neurosurgery ◽  
1981 ◽  
Vol 9 (6) ◽  
pp. 631-637 ◽  
Author(s):  
Chris E. U. Ekong ◽  
Michael L. Schwartz ◽  
Charles H. Tator ◽  
David W. Rowed ◽  
Virginia E. Edmonds
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Halo Vest ◽  
Cord Injury ◽  
Type 3 ◽  
Halo Device

Abstract Twenty-two patients with C-2 fractures involving the odontoid process were treated by immobilization in a halo device. Six had associated spinal cord injury (1 complete and 5 incomplete), and 16 had no spinal cord injury. The age of the patients ranged from 20 to 86 years, with a mean age of 53. There were 15 cases in which the fracture line went through the base of the odontoid process only (Type 2), 1 case with a Type 2 odontoid fracture associated with a Jefferson fracture, 4 in which the fracture line involved the body of C-2 (Type 3), and 2 cases with a Type 3 odontoid fracture associated with a Jefferson fracture. Eighteen of the patients were followed for at least 6 months (the mean follow-up period was approximately 2/12; years) to determine the results of bony fusion and neurological improvement. Three patients died early: 1 had no spinal cord injury and died of an associated head injury; 2 had spinal cord injuries and died of respiratory failure. One was lost to follow-up. Successful bony healing and stability at the fracture site as indicated by flexion and extension roentgenograms of the cervical spine were achieved in 10 (59%) of 17 patients treated with the halo ring and vest only. Early fusion was required in 1 patient, and late fusion was required in 5 patients. The remaining 2 patients refused operation. Improvement in neurological status was noted in all four surviving patients with spinal cord injury. and none of the patients without spinal cord injury developed a neurological deficit during the course of the halo treatment. The average duration of hospitalization was 27 days for those without spinal cord injury and 70 days for those with spinal cord injury. Complications related directly to the halo devices were few and minor and included scalp infection, pressure sores, loosening of the halo pins, and 1 case of osteomyelitis of the skull. We found that the halo device is useful for immobilizing the cervical spine even in the presence of diminished sensation over the trunk. Except for the presence of certain types of coexisting head injury, an absolute contraindication to its use has not been encountered. The major advantage of the halo vest is that it allows external maneuvering of bony injuries in all three planes followed by fixation when acceptable reduction is attained without the need for early operation in patients who may already be very ill. The halo vest also allows early mobilization of patients and early discharge from the hospital.

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.

Cervical spine injury from gunshot wounds

2014 ◽  
Vol 21 (3) ◽  
pp. 442-449 ◽  
Author(s):  
Narlin Beaty ◽  
Justin Slavin ◽  
Cara Diaz ◽  
Kyle Zeleznick ◽  
David Ibrahimi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Neurological Outcome ◽  
Treatment Algorithm ◽  
Gunshot Wounds ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Cervical Instability ◽  
Cord Injury

Object Gunshot wounds (GSWs) to the cervical spine have been examined in a limited number of case series, and operative management of this traumatic disease has been sparsely discussed. The current literature supports and the authors hypothesize that patients without neurological deficit need neither surgical fusion nor decompression. Patients with GSWs and neurological deficits, however, pose a greater management challenge. The authors have compiled the experience of the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, over the past 12 years, creating the largest series of such injuries, with a total number of 40 civilian patients needing neurosurgical evaluation. The current analysis examines presenting bone injury, surgical indication, presenting neurological examination, and neurological outcome. In this study, the authors characterize the incidence, severity, and recovery potential of cervical GSWs. The rate of unstable fractures requiring surgical intervention is documented. A detailed discussion of surgical indications with a treatment algorithm for cervical instability is offered. Methods A total of 144 cervical GSWs were retrospectively reviewed. Of these injuries, 40 had documented neurological deficits. No neurosurgical consultation was requested for patients without deficit. Epidemiological and clinical information was collected on patients with neurological deficit, including age, sex, timing, indication, type of surgery, initial examination after resuscitation, follow-up examination, and imaging data. Results Twenty-eight patients (70%) presented with complete neurological deficits and 12 patients (30%) presented with incomplete injuries. Fourteen (35%) of the 40 patients underwent neurosurgical intervention. Twelve patients (30%) required intervention for cervical instability. Seven patients required internal fixation involving 4 anterior fusions, 2 posterior fusions, and 1 combined approach. Five patients were managed with halo immobilization. Two patients underwent decompression alone for neurological deterioration and persistent compressive injury, both of whom experienced marked neurological recovery. Follow-up was obtained in 92% of cases. Three patients undergoing stabilization converted at least 1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and the remaining operative cases experienced small ASIA motor score improvement. Eighteen patients underwent inpatient MRI. No patient suffered complications or neurological deterioration related to retained metal. Three of 28 patients presenting with AIS Grade A improved to Grade B. For those 12 patients with incomplete injury, 1 improved from AIS Grade C to D, and 3 improved from Grade D to E. Conclusions Spinal cord injury from GSWs often results in severe neurological deficits. In this series, 30% of these patients with deficits required intervention for instability. This is the first series that thoroughly documents AIS improvement in this patient population. Adherence to the proposed treatment algorithm may optimize neurological outcome and spine stability.

scholarly journals Treatment of Reducible Atlantoaxial Dislocation and Basilar Invagination Using the Head Frame Reduction Technique and Atlantoaxial Arthrodesis

2020 ◽  
pp. 219256822097016
Author(s):  
Teng Li ◽  
Yue-Qi Du ◽  
Yi-Heng Yin ◽  
Shao-Ling Xing ◽  
Guang-Yu Qiao
Keyword(s):  
Treatment Algorithm ◽  
Odontoid Process ◽  
Case Series ◽  
Basilar Invagination ◽  
Reduction Technique ◽  
Atlantoaxial Dislocation ◽  
Retrospective Case ◽  
Neurological Improvement ◽  
Atlantoaxial Arthrodesis

Study design: Retrospective case series. Object: To evaluate the outcomes of a head frame reduction and atlantoaxial arthrodesis technique for the treatment of reducible basilar invagination (BI) and atlantoaxial dislocation (AAD). Methods: Seventy-two reducible BI and AAD cases who were treated with the head frame reduction and atlantoaxial arthrodesis technique from June 2015 to December 2018 were retrospectively analyzed. Radiological measurements including the atlantodental interval (ADI), the height of odontoid process above Chamberlain line, Wackenheim line, clivus-canal angle (CCA) and JOA score were evaluated. Results: There was no death in this series. The follow-up period ranged from 6 to 32 months (mean: 21.2 months). Radiological, complete or 90% reduction was attained and complete decompression was demonstrated in all patients. The CCA increased from 123.22 ± 8.36 preoperatively to 143.05 ± 8.79 postoperatively (P < 0.01). There was no patient found postoperative dysphagia. Neurological improvement was observed in all patients, with the JOA scores increasing from 12.53 ± 1.93 preoperatively to 16.13 ± 1.23 postoperatively (P < 0.01). Solid bony fusion was demonstrated in 69 patients at follow-up (95.8%). Conclusion: Head frame reduction technique is a simple and effective treatment which could relief neurologic compression and adjust the CCA in patients with reducible AAD and BI with lower potential risks. Atlantoaxial fixation with short segmental fixation, strong purchase and low shearing force could maintain superior stabilization. The safety and long-term efficacy of such fixation and reduction technique were favorable, which illustrated that it could be a promising treatment algorithm for such kind of disease.

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.

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