Management of the Fractured Odontoid with Halo-Thoracic Bracing

Schweigel, Joseph F.

doi:10.1097/00007632-198711000-00002

Cited by 42 publications

(25 citation statements)

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“…Both fractures with secondary instability were type II injuries, a fact that confirms the reported higher rate of nonunion for type II fractures in the literature [4,9,21,22,28,32,33].…”

Section: Discussionsupporting

confidence: 80%

“…Many reports have enumerated the risk factors for non-union of odontoid fractures, including initial displacement of the odontoid and non-rigid immobilisation [2,4,9,11,12,14,22]. Whereas rigid immobilisation with a halo device was thought to have a high success rate and was recommended as the method of choice for non-operative treatment [12,21,33,34,35], Polin et al [28] demonstrated that there is no statistical significance regarding differences in fracture healing and late instability between non-rigid and rigid immobilisation. This finding correlates with our experience, demonstrating that a high fusion rate can be achieved with non-rigid immobilisation in stable fractures.…”

Section: Discussionmentioning

confidence: 99%

“…For non-operative treatment, application of a halo device is the method of choice, with a high success rate; however, the number of complications associated with this kind of treatment is high [12,13,21,24,33]. The need for rigid external fixation for successful treatment of type II and III odontoid fractures has never been substantiated in the literature.…”

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confidence: 99%

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Non-rigid immobilisation of odontoid fractures

Müller

Schwinnen

Fischer

et al. 2003

European Spine Journal

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IntroductionThe appropriate treatment of type II and III odontoid fractures still remains controversial. However in the recent literature there seems to be a tendency to opt for primary internal fixation with interfragmentary screws [1,7,8,19,23,29,36]. The reported rate of non-union varies between 2.4% and 100% for all types of fractures and treatment modalities, with the highest rates for untreated fractures and fractures treated with a cervical collar only. Important factors reported to contribute to non-union of these fracAbstract Despite various reports on the management of odontoid fractures, there is no consensus on the subject, and the appropriate treatment still remains controversial. While untreated fractures or fractures treated only with a cervical orthosis seem to have the highest rate of nonunion, the need for rigid external stabilisation has never been substantiated. In a retrospective analysis we reviewed 26 patients with acute type II and III fractures of the odontoid, treated with a cervical orthosis only. Study inclusion was limited to fractures that had a fracture gap of less than 2 mm, an initial antero-posterior displacement of less than 5 mm and angulation of less than 11°, less than 2 mm displacement on lateral flexion/extension views, and were without neurological deficits. These fractures were defined as stable. There were 19 (73.1%) type II and 7 (26.9%) type III fractures; in 10 (38.5%) of these fractures the odontoid was displaced and/or angulated. The overall complication rate was 11.4% (n=3). One patient suffered from pulmonary embolism, in two patients (7.7%) with initially minimally displaced fractures, secondary internal stabilisation had to be performed because of persistent instability. In 20 (77%) of the remaining fractures healing was uneventful. In 4 nondisplaced fractures (15%) fibrous union was documented. Three of these patients were over 65 years old. The overall fusion rate was 73.7% for type II and 85.7% for type III fractures. At follow-up 39% of the patients were free of symptoms; however, the clinical outcome did not correlate with the radiological findings. According to our findings, stable type II and type III fractures of the odontoid can be successfully treated with non-rigid immobilisation, even if they are displaced. A thorough assessment of the stability of the odontoid with lateral flexion/extension views or dynamic fluoroscopy is recommended to evaluate the appropriate treatment. Nonrigid immobilisation may be an option in selected cases with stable injuries.

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“…Both fractures with secondary instability were type II injuries, a fact that confirms the reported higher rate of nonunion for type II fractures in the literature [4,9,21,22,28,32,33].…”

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Non-rigid immobilisation of odontoid fractures

Müller

Schwinnen

Fischer

et al. 2003

European Spine Journal

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“…However, the number of complications associated with this form of treatment is high [13][14][15][16]. When we evaluated the role of device type on long-term functional outcome, we found that use of cervical orthosis devices, such as cervical collars, had superior outcome results with regard to neck pain, shoulder and arm pain, physical symptoms and psychological distress.…”

Section: Discussionmentioning

confidence: 99%

The long-term functional outcome of type II odontoid fractures managed non-operatively

et al. 2010

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Odontoid fractures currently account for 9-15% of all adult cervical spine fractures, with type II fractures accounting for the majority of these injuries. Despite recent advances in internal fixation techniques, the management of type II fractures still remains controversial with advocates still supporting non-rigid immobilization as the definitive treatment of these injuries. At the NSIU, over an 11-year period between 1 July 1996 and 30 June 2006, 66 patients (n = 66) were treated by external immobilization for type II odontoid fractures. The medical records, radiographs and CT scans of all patients identified were reviewed. Clinical follow-up evaluation was performed using the Cervical Spine Outcomes Questionnaire (CSOQ). The objectives of this study were to evaluate the long-term functional outcome of patients suffering isolated type II odontoid fractures managed non-operatively and to correlate patient age and device type with clinical and functional outcome. Of the 66 patients, there were 42 males and 24 females (M:F = 1.75:1) managed non-operatively for type II odontoid fractures. The mean follow-up time was 66 months. Advancing age was highly correlated with poorer long-term functional outcomes when assessing neck pain (r = 0.19, P = 0.1219), shoulder and arm pain (r = 0.41, P = 0.0007), physical symptoms (r = 0.25, P = 0.472), functional disability (r = 0.24, P = 0.0476) and psychological distress (r = 0.41, P = 0.0007). Patients [65 years displayed a higher rate of pseudoarthrosis (21.43 vs. 1.92%) and established non-union (7.14 vs. 0%) than patients\65 years. The non-operative management of type II odontoid fractures is an effective and satisfactory method of treating type II odontoid fractures, particularly those of a stable nature. However, patients of advancing age have been demonstrated to have significantly poorer functional outcomes in the long term. This may be linked to higher rates of non-union.

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“…Its treatment remains quite challenging because of the associated risk owing to the complex anatomy of the cranio-cervical junction. The conservative treatment includes cervical orthoses, halo vests, and jackets, which may allow for the fracture to fuse without the need for surgical intervention [17,20,22,24]. However, these methods are poorly tolerated in the elderly and the multiply injured patients [18,19].…”

Section: Introductionmentioning

confidence: 99%

Management of odontoid fractures with percutaneous anterior odontoid screw fixation

Chi

Wang

et al. 2007

Eur Spine J

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Minimally invasive techniques have revolutionized the management of a variety of spinal disorders. The authors of this study describe a new instrument and a percutaneous technique for anterior odontoid screw fixation, and evaluate its safety and efficacy in the treatment of patients with odontoid fractures. Ten patients (6 males and 4 females) with odontoid fractures were treated by percutaneous anterior odontoid screw fixation under fluoroscopic guidance from March 2000 to May 2002. Their mean age at presentation was 37.2 years (with a range from 21 to 55 years). Six cases were Type II and four were Type III classified by the Anderson and D'Alonzo system. The operation was successfully completed without technical difficulties, and without any soft tissue complications such as esophageal injury. No neurological deterioration occurred. Satisfactory results were achieved in all patients and all of the screws were in good placement. After a mean follow-up of 15.7 months (range 10-25 months), radiographic fusion was documented for 9 of 10 patients (90%). Neither clinical symptoms nor screw loosening or breakage occurred. Our preliminary clinical results suggest that the percutaneous anterior odontoid screw fixation procedure using a new instrument and fluoroscopy is technically feasible, safe, useful, and minimally invasive.

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Management of the Fractured Odontoid with Halo-Thoracic Bracing

Cited by 42 publications

References 0 publications

Non-rigid immobilisation of odontoid fractures

Non-rigid immobilisation of odontoid fractures

The long-term functional outcome of type II odontoid fractures managed non-operatively

Management of odontoid fractures with percutaneous anterior odontoid screw fixation

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