Odontoid Fracture

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.

The Dens: Normal Development, Developmental Variants and Anomalies, and Traumatic Injuries

“…Studies report an incidence of nonunion with non-surgical immobilization in roughly 26–30% of cases. [ 12 13 ] Risk factors of developing nonunion after non-surgical treatment include an age greater than 50 years at the time of injury (21 times more likely to fail immobilization compared to younger patients, Class II data),[ 17 ] greater than 6 mm dens displacement in any direction,[ 11 18 ] and moderate fracture comminution. Thus, halo immobilization is most successful in younger patients (<50 years of age) with minimal fracture displacement and no or minimal comminution.…”

Epidemiology of C2 Fractures in the 21st Century: A National Registry Cohort Study of 6,370 Patients from 1997 to 2014

“…Nonsurgical treatment of C2 fractures is commonly performed with a rigid cervical collar [ 16 ]. In cases of instability or dislocations a halo-vest treatment is possible [ 17 , 18 ].…”

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up

“…[23][24][25][26] However, it is contraindicated when the fracture line is oblique and anterior. 27 A type IIC fracture with an oblique fracture line from posterior to anterior is considered contraindicated to anterior fixation due to the difficulty associated with interfragmentary compression by the odontoid screw occurring. 28 This suggests the feasibility of posterior temporary screw fixation for C1-C2 complex fractures.…”