Surgical outcome of type II odontoid fracture, Harms technique

Abstract

Background: Cervical trauma is a common cause of disability following spinal cord injury especially in athletic populations. The biomechanics in the atlantoaxial joint carry more than 50% of the rotational movement which can be affected in transverse ligament tear associated with odontoid fracture type II. Odontoid fracture type II is considered an unstable fracture with a high rate of nonunion in conservative treatment. Limitation of the odontoid screws in some cases gives the chance of posterior cervical fixation to have the superior role. Use of polyaxial screws in Harms technique gives the best results in maintaining majority of the biomechanics.Purpose: Our aim in this study is to evaluate Harms technique in patients regarding pain improvement and restoration of the motor power and to report the complications.Study design: This is a retrospective case series study. We used the Frankel grading system to evaluate the postoperative neurological state. , 12 patients were introduced to the neurosurgical department at the Sohag University Hospital with post-traumatic type II odontoid fracture with failure of conservative treatment and not suitable for anterior odontoid screws. All patients underwent full laboratory, medical, and neurological evaluation and imaging study on the cervical spine. All patients underwent posterior cervical fixation C1-C2 by polyaxial screw Harms technique. Results: Male ratio was predominant in our study: 75% with a mean age 34.4 years. Neck pain with limitation of the neck movement was the complaint for the all cases. Three cases came with neurological affection. Postoperative superficial infection reported in one patient; no vertebral artery or neural injuries were noticed in our study. Conclusion: Harms technique C1-C2 fixation is a valuable choice in patients with type II odontoid fracture with failure of conservative treatment or not suitable for odontoid screw. Harms technique gives us the highest preservation of the biomechanics among the other posterior approaches. Trial registration: NCT03768843.

Neurological recovery after surgical intervention of a complete spinal cord injury secondary to a chronic untreated odontoid neck fracture: a lesson in patient prognostication

“…The potential space in between the odontoid and the posterior arch of the C1 vertebra allows for some degree of displacement without severe neurological compromise. That mentioned is the reason why those presenting late for odontoid non-union have functional neurological grading (ASIA D or E) and rarely a Grade A as in this case 7. There is a negative relationship between delay in management and diameter of cord.…”

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

“…Odontoid fractures are more commonly seen in higher velocity impacts, and although odontoid fractures in the elderly are not rare, an injury this severe, given the mechanism of a ground-level fall, is extremely unusual. For the elderly population, the odontoid fractures can occur from low energy impacts such as falls from standing positions, likely due to decreased bone density; with hyperextension of the C-spine, causing the head of C1 to be pushed backwards being the most common mechanism of injury [6][7][8]. Hyperflexion can also lead to odontoid fractures due to the transmission of excess forces via the transverse ligament [2].…”

“…There may also be transverse ligament tears associated with type II fractures. Many type II fractures can mimic transverse ligament injuries with the loss of translational restriction of C1 on C2, increasing the risk of spinal cord injury and cranio-cervical deformities with poor healing [ 8 ]. However, in our patient, on MRI, there was no indication of significant ligamentous damage and displacement in her MRI.…”

“…Many in the elderly population are at higher risk of surgical complications due to co-morbidities or poor bone quality but type II odontoid fractures are considered inherently unstable and are at increased risk of nonunion due to poor vascularity of the odontoid process [ 8 ]. There are high rates of nonunion with conservative management in elderly patients [ 1 , 5 , 8 ]; patients over 50 have a 21-fold greater incidence of nonunion with surgical management [ 15 ].…”

“…Many in the elderly population are at higher risk of surgical complications due to co-morbidities or poor bone quality but type II odontoid fractures are considered inherently unstable and are at increased risk of nonunion due to poor vascularity of the odontoid process [ 8 ]. There are high rates of nonunion with conservative management in elderly patients [ 1 , 5 , 8 ]; patients over 50 have a 21-fold greater incidence of nonunion with surgical management [ 15 ]. Chapman et al in their study of 322 patients over 65 with type II odontoid fractures found that surgical treatment did not negatively impact survival; in fact, their study showed an improvement in 30-day survival and improved long-term survival with the surgical intervention [ 16 ].…”