The Effect of Soft-Tissue Restraints After Type II Odontoid Fractures in the Elderly

McCabe, Colin; McLachlin, Stewart D.; Bailey, Stewart I.; Gurr, Kevin R.; Bailey, Christopher S.; Dunning, Cynthia E.

doi:10.1097/brs.0b013e31823b4ed0

Cited by 18 publications

(17 citation statements)

References 22 publications

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“…This amount of subluxation is consistent with findings in an vitro isolated Oc-C2 model wherein, in the presence of a Type II odontoid fracture, 10 N of force applied directly anteriorly to C2 resulted in 3.0±0.9 mm of subluxation relative to C1. 48 Therefore, our “force-corrected” data agrees quantitatively with direct observations made by other investigators and supports the concept that the force vector (not just force magnitude ) may be key in determining the motion of an unstable cervical segment.…”

Section: Discussionsupporting

confidence: 90%

“…19,20 Accordingly, in virtually all in vitro studies of segmental spinal motion, force/motion characteristics are determined only after at least two load cycles. 20,21,47,48 We had anticipated that, because of in vitro tissue preconditioning, cadaver intubation biomechanics might change with repeated intubations. However, the effect was greater than anticipated, as evidenced by marked deformation of cadaver airway tissue (tongue) after high force Macintosh intubations.…”

Section: Discussionmentioning

confidence: 99%

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Intubation Biomechanics

et al. 2015

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Introduction The aims of this study were to characterize: 1) cadaver intubation biomechanics, including the effect of repeated intubations; and 2) the relationship between intubation force and the motion of an injured cervical segment. Methods Fourteen cadavers were serially intubated using force-sensing Macintosh and Airtraq laryngoscopes in random order, with simultaneous cervical spine motion recorded with lateral fluoroscopy. Motion of the C1-C2 segment was measured in the intact and injured state (Type II odontoid fracture). Injured C1-C2 motion was proportionately corrected for changes in intubation forces that occurred with repeated intubations. Results Cadaver intubation biomechanics were comparable to those of patients in all parameters other than C2-C5 extension. In cadavers, intubation force (Set 2/Set1 force ratio = 0.61 [95% CI: 0.46, 0.81]; P=0.002) and Oc-C5 extension (Set 2 –Set 1 difference = −6.1 degrees [95% CI: −11.4, −0.9]; P=0.025) decreased with repeated intubations. In cadavers, C1-C2 extension did not differ: 1) between intact and injured states; or 2) in the injured state, between laryngoscopes (with and without force correction). With force correction, in the injured state, C1-C2 subluxation was greater with the Airtraq (mean difference 2.8 mm [95% CI: 0.7, 4.9 mm]; P=0.004). Discussion With limitations, cadavers may be clinically relevant models of intubation biomechanics and cervical spine motion. In the setting of a Type II odontoid fracture, C1-C2 motion during intubation with either the Macintosh or Airtraq does not appear to greatly exceed physiologic values or to have a high likelihood of hyperextension or direct cord compression.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Intubation Biomechanics

et al. 2015

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“…Due to the characteristics of the two injury mechanisms the incidence has a double peak distribution with fractures related to major trauma occurring in the younger patients, while osteoporotic fractures occur commonly in the elderly [4–6]. Odontoid fractures of the elderly related to osteoporosis often have intact C1-C2 joint capsules, anterior longitudinal ligament, and accessory ligaments, which stabilise the osteoporotic type II odontoid fracture produced in a low-energy mechanism [7]. Therefore type II odontoid fractures in the young and in the elderly are two different injuries, and different treatment protocols may be necessary.…”

Section: Introductionmentioning

confidence: 99%

Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

Robinson

Olerud

2014

BioMed Research International

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Odontoid fractures type II according to Anderson and d'Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.

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“…These biomechanical alterations are not surprising because transoral odontoidectomy profoundly alters the anatomy of the CVJ. [ 25 31 32 ] During surgery, the primary stabilizing components are detached or removed, including the dens, the alar ligaments, and the transverse atlantal ligament. A great contribution to decrease the postoperative risk of spinal instability is the preservation of the anterior C1 arch.…”

Section: Discussionmentioning

confidence: 99%

C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: A case report

Zenga¹,

Marengo²,

Pacca³

et al. 2015

Surg Neurol Int

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Background:The transoral ventral corridor is the most common approach used to reach the craniovertebral junction (CVJ). Over the last decade, many case reports have demonstrated the transnasal corridor to the odontoid peg represents a practicable route to remove the tip of the odontoid process. The biomechanical consequences of the traditional odontoidectomy led to the necessity of a cervical spine stabilization. Preserving the inferior portion of the C1 anterior arch should prevent instability.Case Description:This is the first report in which the technique to remove the tip of the odontoid while preserving the C1 anterior arch is described by means of a three-dimensional (3D) endoscope. A 53-year-old man underwent a transnasal 3D endoscopic approach because of a complex CVJ malformation. The upper-medial portion of the C1 anterior arch was removed preserving its continuity, and the odontoidectomy was performed. After surgery, a dynamic X-ray scan showed no difference in CVJ motility in comparison with the preoperative one.Conclusions:The stereoscopic perception augmented the precision of the surgical gesture in the deep field. The importance of a 3D view relates to the depth of field, which a two-dimensional endoscopy cannot provide. This affects the preservation of the C1 anterior arch because of the presence of critical structures that are exposed to potential damage if not displayed.

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The Effect of Soft-Tissue Restraints After Type II Odontoid Fractures in the Elderly

Abstract: This study identifies that type II odontoid fractures without associated soft-tissue injury may be stable under certain loading modes.

Cited by 18 publications

References 22 publications

Intubation Biomechanics

Intubation Biomechanics

Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

C1 anterior arch preservation in transnasal odontoidectomy using three-dimensional endoscope: A case report

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