Odontoid process fractures: the role of the ligaments in maintaining stability. A biomechanical, cadaveric study

Boughton, Oliver; Bernard, J; Szarko, Matthew

doi:10.1051/sicotj/2015011

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…In the only similar case in which C2 OO was removed through a transoral endoscope-assisted approach, subsequent stabilization through C1-C2 posterior fixation was required to overcome the atlanto-axial instability given by the complete removal of the C1 anterior arch and the base of the odontoid [ 16 ]. Cranio-vertebral and atlanto-axial joint (CVAAJ) stability is a debated topic; in this complex architecture, both bone surfaces and ligaments are thought to determine the stability and motility of these joints [ 25 , 26 , 27 ]. The risk of instability after CVAAJ surgery, on the one hand, and the determination of bone and soft tissue involvement in maintaining its stability, on the other, are yet debated.…”

Section: Discussionmentioning

confidence: 99%

“…The risk of instability after CVAAJ surgery, on the one hand, and the determination of bone and soft tissue involvement in maintaining its stability, on the other, are yet debated. However, the contribution of ligaments and periarticular soft tissues in maintaining CVAAJ stability has been pointed out; in particular, preservation of periarticular soft tissue ensures a certain degree of post-operative stability, thus preventing further vertebral fixation [ 25 , 26 , 27 ]. In keeping with this evidence, the patient did not undergo vertebral fixation since a low risk of post-operative CVAAJ instability was estimated.…”

Section: Discussionmentioning

confidence: 99%

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Transnasal Endoscopic Approach for Osteoid Osteoma of the Odontoid Process in a Child: Technical Note and Systematic Review of the Literature

et al. 2022

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Osteoid osteoma (OO) is a primary benign tumor that accounts for up to 3% of all bone tumors. The cervical spine is less affected by OOs, and very few cases of C2 OOs have been reported in the literature, both in adults and children. Surgery may be required in case of functional torticollis, stiffness, and reduced range of motion (ROM) due to cervical OOs refractory to medical therapy. Several posterior and anterior surgical techniques have been described to remove C2 OOs. In particular, anterior approaches to the cervical spine represent the most used surgical route for treating C2 OOs. We describe the first case of OO of the odontoid process removed through a transnasal endoscopic approach with the aid of neuronavigation in a 6-year-old child. No intraoperative complications occurred, and the post-operative course was uneventful. The patient had immediate relief of neck pain and remained pain-free throughout the follow-up period, with complete functional recovery of the neck range of motion (ROM). In this case, based on the favorable anatomy, the transnasal endoscopic approach represented a valuable strategy for the complete removal of an anterior C2 OO without the need for further vertebral fixation since the preservation of ligaments and paravertebral soft tissue.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Transnasal Endoscopic Approach for Osteoid Osteoma of the Odontoid Process in a Child: Technical Note and Systematic Review of the Literature

et al. 2022

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“…Only 3 patients had partial ligamentous tears, and one of these was a cruciate ligament. 7,31 This shows that routine MRI for C2 fractures is not mandatory if fractures are clinically and radiologically stable and require subsequent conservative management. However, for academic and medicolegal purposes, this modality is often necessary.…”

Section: Discussionmentioning

confidence: 99%

Fractures of C2 (Axis) Vertebra: Clinical Presentation and Management

et al. 2020

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Background: Injuries of the upper cervical spine are a major cause of morbidity and mortality due to associated spinal cord and head injuries. The injury patterns of the upper cervical spine are numerous, and the neurologic sequelae are diverse. The axis (C2) is the most commonly fractured vertebra in the upper cervical spine; its unique anatomy and architecture pose difficulties in the diagnosis and the management of its fractures.Methods: All cases of acute spinal injuries at Prince Mohammed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia, were screened for fractures of C2 vertebrae. These patients underwent computerized tomography (CT) imaging of the cervical spine with special attention paid to the cranio-cervical junction. Magnetic resonance imaging (MRI) and angiography of the neck were performed to exclude ligamentous tears and vascular injuries. Unstable fractures were fixed surgically. In the remaining cases, a conservative trial was given. All patients were followed up once every 3 months for a period of 1 year. During follow-up, some patients underwent additional CT imaging of the cervical spine to monitor the healing of fractures.Results: Out of 230 spinal trauma patients, 43.5% suffered from cervical spine injury. C2 fractures were recorded in 26% cases, and fractures of the C2 vertebral body, including pedicles, laminae, lateral masses, and articular processes, were found in many cases, followed by odontoid fractures (50%). No case of atlanto-axial or atlanto-occipital dislocation was recorded. Road traffic accidents were found to be responsible for 92% of cases. The majority of patients were young males, and 96% of patients had no neurological deficit. Only 15% of the patients required surgery for their unstable fractures. Half of the patients attended outpatient follow -up appointments, all of whom underwent CT scanning of the cervical spine 9 months after the accident or operation.Conclusions: The axis (C2) is the most commonly affected vertebra in cervical spine trauma, and odontoid fractures make up 50% of all C2 fractures. C2 fractures rarely cause any neurological deficit or vascular injury, and the majority of affected patients can be managed conservatively; only a small proportion requires surgical intervention. Surgical intervention leads to early and complete healing.

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