Spinal Cord Transection in a Type II Odontoid Fracture From a Ground-Level Fall

Agunbiade, Samiat; Belton, Patrick; Mesfin, Fassil B.

doi:10.7759/cureus.12342

Cited by 2 publications

(2 citation statements)

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“…Stability of injury by measuring anteroposterior displacement >3.5 mm and perceived spinal canal invasion are insufficient for injury severity. Agunbiade, et al described a patient with complete cervical cord transection from a ground-level fall in a patient with minimal radiological evidence for spinal cord injury from mildly displaced odontoid fracture [12]. Disruption of the ligamentous tissues and re-alignment in cervical collar during emergency evaluation with routine imaging could miss neurological injury.…”

Section: Discussionmentioning

confidence: 99%

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

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Doan

Vanier

et al. 2022

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Background: Odontoid fractures are common and projected to increase. Comorbidities compound risk of surgery and balancing the risk of non-operative management is controversial. Stable fractures are managed based on patient comorbidity with suspected clinical prognosis. Type I and III fractures are typically managed safely with cervical orthoses. Management decisions of type II fractures however, come under frequent debate. This paper evaluates overall morbidity and mortality, and outcomes of operative and non-operative management. Methods: We performed national database review of C2 fractures from January 2014 to December 2019. Patients were divided into categories based on Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). Outcomes data considered hospital admission, Intensive Care Unit (ICU) admission, hospital length of stay (LOS), ICU LOS, and mortality. Logistic regression was used for mortality, hospital admission, and ICU admission. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from the logistic regression models. The Kruskal-Wallis test was used to compare the hospital and ICU LOS based on surgery overall, and by GCS and ISS. Results: 42,003 patients were identified, 9,187 had surgery with overall mortality rate of 0.7%. There was a younger operative median age (67) and interquartile range (IQR: 47, 78) than non-operative group (73, IQR: 56, 83). Both had the same median ISS score (10). Surgery was associated with lower rates of mortality, from 0.1% to 0.9% mortality for non-operative. Mild or moderate GCS mortality improved operative (0.07%) to non-operative (0.23%). Severe GCS patients with surgery had significantly improved mortality rates patients without (0.29% vs 7.69%, respectively). Surgery increased ICU admissions for every ISS category. Severe GCS had higher chances of ICU admission, but no interaction with surgery. Operative patients had longer hospital and ICU stays. For all GCS and ISS categories, hospital and ICU LOS was longer for operative patients. Conclusions: This review demonstrates significant improvement in mortality with operative management. Standard non-operative management of type I and III C2 fractures is appropriate. Surgeons should consider operating on type II odontoid fractures unless patient cannot undertake the surgical risks of induction with general anesthesia. Level of evidence: Level IV

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Section: Discussionmentioning

confidence: 99%

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

Foote

Doan

Vanier

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…Stability of injury by measuring anteroposterior displacement >3.5 mm and perceived spinal canal invasion are insu cient for injury severity. Agunbiade, et al described a patient with complete cervical cord transection from a ground-level fall in a patient with minimal radiological evidence for spinal cord injury from mildly displaced odontoid fracture [12].…”

Section: Los In Hospital and Icumentioning

confidence: 99%

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

Foote

Doan

Vanier

et al. 2022

Preprint

View full text Add to dashboard Cite

Background:Odontoid fractures are common and projected to increase. Comorbidities compound risk of surgery and balancing the risk of non-operative management is controversial. Stable fractures are managed based on patient comorbidity with suspected clinical prognosis. Type I and III fractures are typically managed safely with cervical orthoses. Management decisions of type II fractures however, come under frequent debate. This paper evaluates overall morbidity and mortality, and outcomes of operative and non-operative management. Methods:We performed national database review of C2 fractures from January 2014 to December 2019. Patients were divided into categories based on Glasgow Coma Scale (GCS) and Injury Severity Score (ISS). Outcomes data considered hospital admission, Intensive Care Unit (ICU) admission, hospital length of stay (LOS), ICU LOS, and mortality. Logistic regression was used for mortality, hospital admission, and ICU admission. Odds ratios (OR) and 95% confidence intervals (CI) were calculated from the logistic regression models. The Kruskal-Wallis test was used to compare the hospital and ICU LOS based on surgery overall, and by GCS and ISS.Results:42,003 patients were identified, 9,187 had surgery with overall mortality rate of 0.7%. There was a younger operative median age (67) and interquartile range (IQR: 47, 78) than non-operative group (73, IQR: 56, 83). Both had the same median ISS score (10). Surgery was associated with lower rates of mortality, from 0.1% to 0.9% mortality for non-operative. Mild or moderate GCS mortality improved operative (0.07%) to non-operative (0.23%). Severe GCS patients with surgery had significantly improved mortality rates patients without (0.29% vs 7.69%, respectively). Surgery increased ICU admissions for every ISS category. Severe GCS had higher chances of ICU admission, but no interaction with surgery. Operative patients had longer hospital and ICU stays. For all GCS and ISS categories, hospital and ICU LOS was longer for operative patients.Conclusions:This review demonstrates significant improvement in mortality with operative management. Standard non-operative management of type I and III C2 fractures is appropriate. Surgeons should consider operating on type II odontoid fractures unless patient cannot undertake the surgical risks of induction with general anesthesia.Level of evidence: Level IV

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Spinal Cord Transection in a Type II Odontoid Fracture From a Ground-Level Fall

Cited by 2 publications

References 18 publications

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

C2 Fracture Operative and Non-Operative Management Outcomes in Large Database Review

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