scholarly journals Endoscopically-Assisted Percutaneous Unilateral Atlantoaxial Screw-Rod Nonfusion Fixation Treatment for Type II Odontoid Fractures in Geriatric Patients: Case Series and Technical Note

2020 ◽  
Vol 2;23 (4;2) ◽  
pp. E241-E250
Author(s):  
Zhong-Liang Deng
Keyword(s):  
Geriatric Patients ◽  
Spinal Injury ◽  
Neck Disability Index ◽  
Case Series ◽  
Optimal Treatment ◽  
Bone Union ◽  
Full Time ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Increased Risk

Background: Considerable controversy exists regarding the optimal treatment for type II odontoid fractures in geriatric patients. Surgical intervention can help patients return to their prior level of function as rapidly as possible while avoiding the morbidity and mortality associated with prolonged and bedbound hospitalization. However, the optimal treatment is still a difficult choice for patients with increased risk from anesthesia. Objectives: The objective of our study was to describe an innovative method of endoscopically-assisted percutaneous unilateral C1 lateral mass screw and C2 pedicle screwrod nonfusion fixation for type II odontoid fractures in geriatric patients. Study Design: A case series design and technical notes. Setting: This study took place at Second Affiliated Hospital of Chongqing Medical University. Methods: Seven geriatric patients (> 65 years) with type II odontoid fractures and an American Society of Anesthesiologists (ASA) score of 2 or higher received endoscopicallyassisted percutaneous unilateral atlantoaxial screw-rod nonfusion fixation. After surgery, all patients were required to wear a rigid collar full-time for 12 weeks. Intraoperative data, the bone union time, American Spinal Injury Association (ASIA) scale scores, Neck Disability Index (NDI) scores, and postoperative complications were collected for assessment. Results The surgical goal was successfully achieved in all patients, 3 of whom had high ASA scores (≥3) and underwent surgery under local anesthesia. The operative time ranged from 112 to 169 minutes (mean, 131.1 minutes). No neurovascular complications were observed intraoperatively or postoperatively. All patients rapidly returned to their prior level of function and were followed up for 12 to 24 months (average: 16.9 months). Bone union was achieved in all patients. Limitations: This study is limited by being a retrospective study. Conclusions: Endoscopically-assisted percutaneous unilateral atlantoaxial screw-rod nonfusion fixation is a feasible technique for type II odontoid fractures in geriatric patients. This method offers a compromise between non-operative and operative treatment and allows geriatric patients to rapidly return to their prior level of function. Key words: Endoscopically-assisted surgery; geriatric patient; percutaneous atlantoaxial fixation; type II odontoid fracture; unilateral nonfusion fixation

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

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.

scholarly journals The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

2012 ◽  
Vol 22 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Jeroen G. J. Huybregts ◽  
Wilco C. H. Jacobs ◽  
Carmen L. A. M. Vleggeert-Lankamp
Keyword(s):  
Systematic Review ◽  
The Elderly ◽  
Optimal Treatment ◽  
Type Ii ◽  
Odontoid Fractures

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.

Percutaneous Drilling of Symptomatic Accessory Navicular in Young Athletes

2005 ◽  
Vol 33 (4) ◽  
pp. 531-535 ◽  
Author(s):  
Shoichiro Nakayama ◽  
Kazuya Sugimoto ◽  
Yoshinori Takakura ◽  
Yasuhito Tanaka ◽  
Ryoji Kasanami
Keyword(s):  
Symptomatic Relief ◽  
Proximal Phalanx ◽  
Case Series ◽  
Bone Union ◽  
Type Ii ◽  
Great Toe ◽  
Young Athletes ◽  
Level Of Evidence ◽  
Accessory Navicular ◽  
Tarsal Navicular Bone

Background Results of percutaneous drilling for symptomatic type II accessory tarsal navicular bone are not determined. Hypothesis Percutaneous drilling of accessory navicular synchondrosis will induce or accelerate bone union between the accessory and primary navicular bones. Bone union of the synchondrosis leads to symptomatic relief. Study Design Case series; Level of evidence, 4. Methods Thirty-one feet of 29 patients with type II accessory tarsal navicular treated by percutaneous drilling were reviewed. Results Twenty-four feet (77.4%) were assessed as excellent, 6 (19.4%) as good, and 1 (3.2%) as fair. No feet were assessed as poor. Bone union was obtained in 16 (80%) of the 20 feet when the proximal phalanx of the great toe was immature and in 2 of the 11 feet when it was mature. Conclusion Percutaneous drilling of the synchondrosis was effective for a symptomatic type II accessory navicular, especially in patients with immature proximal phalanx of the great toe.

scholarly journals Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients

2011 ◽  
Vol 20 (11) ◽  
pp. 1915-1920 ◽  
Author(s):  
Michael Osti ◽  
Helmut Philipp ◽  
Berthold Meusburger ◽  
Karl Peter Benedetto
Keyword(s):  
Geriatric Patients ◽  
Screw Fixation ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation

scholarly journals Retrospective analysis of a case series of patients with traumatic injuries to the craniocervical junction

2016 ◽  
Vol 14 (4) ◽  
pp. 528-533
Author(s):  
Luiz Adriano Esteves ◽  
◽  
Andrei Fernandes Joaquim ◽  
Helder Tedeschi ◽  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Case Series ◽  
Craniocervical Junction ◽  
Data Sets ◽  
Type Ii ◽  
Surgical Wound ◽  
Traumatic Injuries ◽  
Odontoid Fractures ◽  
Posterior Elements

ABSTRACT Objective To evaluate the correlation between the treatment, the characteristics of the lesions and the clinical outcome of patients with traumatic injuries to the craniocervical junction. Methods This was a retrospective study of patients treated conservatively or surgically between 2010 and 2013 with complete data sets. Results We analyzed 37 patients, 73% were men with mean age of 41.7 years. Of these, 32% were submitted to initial surgical treatment and 68% received conservative treatment. Seven (29%) underwent surgery subsequently. In the surgical group, there were seven cases of odontoid type II fractures, two cases of fracture of posterior elements of the axis, one case of C1-C2 dislocation with associated fractured C2, one case of occipitocervical dislocation, and one case of combined C1 and C2 fractures, and facet dislocation. Only one patient had neurological déficit that improved after treatment. Two surgical complications were seen: a liquoric fistula and one surgical wound infection (reaproached). In the group treated conservatively, odontoid fractures (eight cases) and fractures of the posterior elements of C2 (five cases) were more frequent. In two cases, in addition to the injuries of the craniocervical junction, there were fractures in other segments of the spine. None of the patients who underwent conservative treatment presented neurological deterioration. Conclusion Although injuries of craniocervical junction are relatively rare, they usually involve fractures of the odontoid and the posterior elements of the axis. Our results recommend early surgical treatment for type II odontoid fractures and ligament injuries, the conservative treatment for other injuries.

scholarly journals Functional and goniometric outcomes after surgical treatment of odontoid fractures

2015 ◽  
Vol 42 (S1) ◽  
pp. S50-S50
Author(s):  
R Kesarwani ◽  
A Nataraj
Keyword(s):  
Short Form ◽  
Neck Disability Index ◽  
Surgical Approaches ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Neck Function ◽  
Atlantoaxial Fixation ◽  
Neck Rotation ◽  
Neck Disability ◽  
And Function

Background: Surgical approaches to stabilize Type-II odontoid fractures include posterior atlantoaxial fixation (PAF) and anterior screw fixation (ASF). While ASF may theoretically allow for greater preservation of neck motion compared to PAF, there is a lack of evidence that one method preserves rotation and function better than the other. Methods: Single-centre study involving patients under 75 years old who underwent surgery for Type-II odontoid fracture. Following chart review, degree of neck rotation was assessed in patients using goniometric measurements. Participants completed questionnaires to investigate their perception of neck function and overall health (Neck Disability Index, Short Form-12, and EuroQol 5-D). Results: Patient recruitment is ongoing. To date, eleven patients have been reviewed (7 PAF, 4 ASF). Mean patient age was 61+/−12 years in the PAF group and 52+/−16 years in the ASF group. Measured neck rotation was lower in the PAF group compared to the ASF group (mean 58 vs. 110.5 degrees). However, the PAF group also reported fewer functional complaints. Conclusions: Preliminary data suggest that patients who receive ASF tend to be younger. While range of neck rotation is superior in ASF patients, their perception of functional ability does not correlate, suggesting that perceived neck function is multifactorial.

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