scholarly journals One-year follow-up for type II odontoid process fractures in octogenarians: Is there a place for surgical management?

2020 ◽  
Vol 11 ◽  
pp. 285
Author(s):  
Francois Borsotti ◽  
Daniele Starnoni ◽  
Timo Ecker ◽  
Juan Barges Coll
Keyword(s):  
Surgical Management ◽  
Injury Severity ◽  
Odontoid Process ◽  
Group Versus ◽  
Mortality Rates ◽  
Magnetic Resonance Images ◽  
X Rays ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Computed Tomography Images

Background: Type II odontoid fractures are becoming one of the most common injuries among elderly patients and are associated with increased morbidity rates. Here, we compared the safety/efficacy of conservative versus surgical treatment for type II C2 fractures and, in particular, evaluated the complications, hospital lengths of stay, and mortality rates for patients over 80 years of age. Methods: We retrospectively reviewed the records of 63 nonsurgically versus 18 surgically treated C2 fractures in patients over 80 years of age (2003–2018). Cervical computed tomography images, X-rays, and magnetic resonance images were reviewed by both a neurosurgeon and a neuroradiologist. The following patient data were included in the analysis; Glasgow Coma Scale score, injury severity score, the abbreviated injury scale scores, their comorbidities (e.g., utilizing the Charlson comorbidity index), their primary outcomes, and mortality rates (e.g., at 6 weeks and 1 year after treatment). Results: Eighty-one patients were included in the study; 63 were treated conservatively and 18 underwent surgical management of type II C2 fractures. Patients averaged 87.0 ± 5.0 years of age, and their combined mortality rates were 13.6% at 6 weeks and 25.9% at 1 year. Notably, at 1 year, the mortality rates were not statistically different between the two groups: 18 (30.0%) patients from the conservatively treated group versus 3 (16.7%) patients from the surgically managed patients died indicating (e.g., using the Kaplan–Meier analysis) no survival advantage for either treatment strategy. Conclusion: Surgical versus conservative management of type II odontoid fractures were associated with comparable high mortality rates at 1 year.

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.

Biomechanical evaluation of a bioresorbable odontoid screw

2005 ◽  
Vol 2 (2) ◽  
pp. 182-187 ◽  
Author(s):  
Christopher P. Ames ◽  
Neil R. Crawford ◽  
Robert H. Chamberlain ◽  
Vivek Deshmukh ◽  
Belma Sadikovic ◽  
...  
Keyword(s):  
Ultimate Strength ◽  
Odontoid Process ◽  
Type Ii ◽  
Content Type ◽  
Odontoid Fractures ◽  
Titanium Screws ◽  
Piston Displacement ◽  
Initial Fracture ◽  
Strength And Stiffness ◽  
Fine Print

Object. The authors tested the ability of a resorbable cannulated lag screw composed of a polylactide copolymer to repair Type II odontoid fractures. The resorbable screw was evaluated for its ability to restore strength and stiffness to the fractured odontoid process compared with traditional titanium screws. Methods. Type II odontoid fractures were created in 14 human cadaveric C-2 vertebrae by applying a posterolaterally directed load and piston displacement was measured. Seven of these specimens were repaired using metal screws and seven were repaired using resorbable screws. Specimens were reinjured using the same mechanism as the initial fracture. Values of ultimate strength and stiffness during failure were statistically compared between metal and resorbable screws and between initial fracture and reinjury. Conclusions. The stiffness and ultimate strength during initial fracture were significantly greater than those during reinjury in specimens repaired using resorbable screws or titanium screws (p < 0.001). The resorbable and titanium screws both restored 31% of the initial ultimate strength of the intact specimen (p = 0.95). The stiffness of the fractured odontoid process was restored to 15 and 23% of its initial value by repair with resorbable and metal screws, respectively (p = 0.07). The mode of failure in resorbable screws was usually breakage or bending, whereas that in metal screws was consistently cutout of the proximal shaft of the screw through the anterior C-2 vertebral body.

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

2006 ◽  
Vol 6 (5) ◽  
pp. 122S ◽  
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

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

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.

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.

Anterior Screw Fixation of Posteriorly Displaced Type II Odontoid Fractures

Neurosurgery ◽  
1989 ◽  
Vol 25 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Fred H. Geisler ◽  
Charles Cheng ◽  
Attila Poka ◽  
Robert J. Brumback
Keyword(s):  
Structural Integrity ◽  
Screw Fixation ◽  
Odontoid Process ◽  
Cervical Vertebra ◽  
High Rate ◽  
Posterior Arch ◽  
Treatment Technique ◽  
Type Ii ◽  
Fracture Union ◽  
Odontoid Fractures

Abstract Posteriorly displaced Type II odontoid fractures (Type II-P) are difficult to stabilize in an anatomic position with accepted methods of posterior atlantoaxial arthrodesis. Nine patients with Type II-P odontoid fractures with 4 to 15 mm displacement were treated with anterior odontoid screw stabilization. Seven of these patients had associated fractures or defects of the posterior arch of the first cervical vertebra (C1). Atlantoaxial posterior arthrodesis in these patients would not have been possible initially because of the lack of structural integrity of the posterior arch of C1. Two patients, later in the study, had no injury to the ring of C1. The odontoid fractures were stabilized with two 4.0-mm cancellous screws inserted through an anterior approach to the neck under fluoroscopic control with the skin incision at the C5 level. Preoperative reduction of the displaced odontoid process and immediate operative stability of the atlantoaxial complex were obtained in each case. No neurological complications related to the procedure occurred. Two patients died of causes unrelated to their cervical fracture surgery. The 7 patients who survived were followed for a minimum of 6 months. Fracture union and cervical stability were demonstrated in each of the surviving patients, without evidence of screw loosening or loss of fixation. Normal range of motion of the neck was documented at follow-up in all surviving patients. Although this series represents a limited experience with this treatment technique, anterior odontoid screw fixation has significant advantages over accepted methods of cervical stabilization for Type II-P odontoid fractures. Immediate cervical stabilization is obtained, with a predictably high rate of fracture union and preservation of atlantoaxial motion. We believe this technique to be the treatment method of choice for Type II-P odontoid fractures displaced 4 mm or more accompanied by fractures of the posterior arch of the first cervical vertebra.

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

2017 ◽  
Vol 27 (5) ◽  
pp. 494-500 ◽  
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.

Fusion rates for conservative and surgical management of type II odontoid fractures and its impact

2021 ◽  
pp. 1-4
Author(s):  
Lauren Harris ◽  
Shahswar Arif ◽  
Matthew Elliot ◽  
Zarina Brady ◽  
Alistair Lawrence ◽  
...  
Keyword(s):  
Surgical Management ◽  
Type Ii ◽  
Odontoid Fractures
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