We found the best clinical results with low rates of non-union as well as low mortality rates following posterior C1/C2 fusion making this our treatment of choice especially in an elderly patient collective. Survival rates were significantly higher among the group of patients who were treated with anterior screw fixation or posterior C1/C2 fusion compared to the conservatively treated group. In patients with a posterior C1-C2 fusion, a bony fusion of the posterior elements was found in 15 of 16 cases (93%). The non-union rate in this cohort was 77%. The mean lateral displacement was 1.9 mm (range 0–5,8 mm) and a mean angulation of 29,1° (range 0-55°) was found.Īnterior screw fixation was carried out in 17 patients. In all other cases (n = 3), radiographs demonstrated non-union. In the non-operatively managed cohort, 11 patients (79%) died postoperatively within a mean period of 23 months. Methodsīetween June 2004 and February 2010, all patients older than 65 years (n = 47) with type II fractures of the odontoid according to the Anderson and D’Alonso classification were retrospectively reviewed. The aim of this study was to compare the outcome of the three treatment modalities in elderly patients. Surgical procedures include either anterior screw fixation of the odontoid or posterior C1/C2 fusion. Possible treatment options are either conservative or surgical.
The management of these fractures is controversial. They represent the most common cervical spine injury for patients older than 70 years, the majority being type II fractures (65-74%), which are considered to be relatively unstable. MRI is used for evaluation of ligamentous, disk, spinal cord and soft tissue injuries.Odontoid fractures account for approximately 20% of all fractures of the cervical spine. Furthermore, as odontoid fractures are in the axial plane, CT allows coronal and sagittal reformatting for better depiction. CT is considered a superior modality for fracture visualization and characterization. Successful treatment options include external immobilization with either a hard cervical collar or halo-thoracic vest, or operative management through anterior/posterior fusion techniques.Ĭonventional radiography is frequently firstly used as it is generally readily available, with measurements of fracture displacement and angulation that can be made on lateral cervical views. This fracture type has the best prognosis for healing because of the larger surface area of the fracture. This fracture is considered mechanically unstable, as it allows the atlas and the occiput to now move together as once unit and independent of the rest of the cervical column. There is a very low incidence of non-union, and surgery is seldom indicated for these fracturesĪ Type III odontoid fracture is characterized by a horizontal fracture through the odontoid with extension into the lateral masses of C2. Management comprises of conservative measures with external immobilization using a hard cervical collar. This is the least common type of odontoid fracture and is generally stable. This fracture is therefore described as an oblique avulsion fracture of the tip of odontoid resulting from avulsion of the alar ligament. This is the point of insertion for the alar ligaments. Management of this fracture type can be non-operative (with a halo-thoracic vest) or operative (posterior atlantoaxial arthrodesis or anterior screw fixation).Ī type I odontoid fracture involves the tip of the dens. These fractures are at higher risk of displacement and angulation (in comparison to the type 1 and 3 subtypes) due to distractive forces from the ligamentous attachment of apical and alar ligaments to the proximal fragment. Important prognostic factors for fracture healing (union versus non-union) are the degree of fracture fragment displacement and angulation. It can be caused by either hyper-flexion or hyperextension mechanisms of injury.
This case demonstrates a type 2 odontoid process fracture, a transverse fracture through the base of the dens and represents the most common type of dens fracture.
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