Clinical Outcomes of Halo-Vest Immobilization and Surgical Fusion of Odontoid Fractures

Abstract

or HVI may provide adequate support in type II fracture or type III stable fractures. Posterior fixation of C1-2 achieves higher fusion rates compared to conservative treatment, but is a challenging surgical technique and results in limitations in the cervical range of motion after surgery 5,17,18,22) . Anterior fixation techniques such as direct anterior odontoid screw fixation preserve rotatory motion of the cervical spine, with immediate stabilization of the spine 8,12,24,25) . In this study, we retrospectively analyzed preoperative and postoperative clinical and radiographic findings of patients with odontoid fractures who were treated with either nonsurgical management (HVI) or surgical fixation using the anterior or posterior approach. Efficacy and comparative treatment outcomes of these methods for odontoid type II and III fractures are also discussed. MATERIALS AND METHODSAfter we received approval from our Institutional Review Board, we retrospectively reviewed all patients with high cervical fractures treated between April 1997 and December 2008. We treated 60 patients with high cervical fractures. This study INTRODUCTIONMore than 60% of spinal injuries involve the cervical spine, and about 25% of all cervical spinal injuries affect the axis 6,7) . The most common axis injury is odontoid fracture, of which the majority are type II or type III dens fractures 3,6) . Treatment strategies for odontoid fractures are based on fracture type, the degree of initial dens displacement, the angulation of the dens with respect to the body of C2, and the age of the patient. The nonunion rate for odontoid fractures is between 4% and 64% depending on the fracture site and method of treatment 16,21,26) . Therapeutic options range from conservative treatment, including soft neck collars, rigid cervical orthosis and halo-vest immobilization (HVI), to surgical treatments including anterior screw fixation, posterior C1-2 screw fixation, or transarticular screw fixation. Non-surgical treatment with cervical collar Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, KoreaObjective : In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation. Methods : From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation.Results : There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 typ...

The effectiveness and clinical outcomes of the Minerva cervical thoracicjacket in patients with type II odontoid fractures

“…However, CTJ treatment is a safe and cheap technique in the management of type II odontoid fractures without any complications. Kim et al reported 20 weeks for time to fusion in surgically treated patients and 17.6 weeks in patients treated with the CH; that is, they concluded that surgical patients had a shorter bone-healing time than patients who received a CH (16). The mean bone-healing time was 7.2 weeks in the present study (a range of 4-16 weeks).…”

Cervical pedicle screws fixation treatment the atlantoaxial instability of axis burst fractures

“…Type II fractures involve the base of the odontoid and do not extend into the C2 body and unstable associated with a nonunion rate of at least 32% with nonoperative treatment. [11][12][13] Odontoid fractures can causes the atlantoaxial instability, which may cause neck pain and stiffness, activity limitation, and progressive compression of the spinal cord. [14,4,15] As another special fractures of axis, Hangman's fractures was the pedicles fractures of C2 which may led to traumatic spondylolisthesis of the axis.…”

Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients

“…Conservative management, a regular practice in earlier days, was later followed by prolonged application of halo vest. These techniques invariably lead to non union of the fracture and furthermore caused major discomfort to the patients 1, 2 . It was Nakanishi and Bohler who initially described odontoid screw placement for type II odontoid fractures 3 .…”