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

Abstract

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.

Chronic Neck Pain Associated with an Old Odontoid Fracture: A Rare Presentation

“…We confirmed that the fracture was not an acute one at presentation due to the odontoid fragment characteristics in the CT as described by Blacksin and Avagliano [11]. Neurological deficits are uncommon with this type of fractures [5, 15], combined with the high percentage of missed fractures and probably the low resolution of the equipment or the unavailable use of CT at the time of the fracture 23 years ago, all contributed to miss the fracture at that given time. The long years that the fracture sustained continuous movements of the neck, and the unawareness of the patient of his condition probably contributed to the formation of the mal-union of the fracture, the abnormal regrowth of the bone, and the formation of pseudarthrosis.…”

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

“…Conservative treatment for this patient cohort has been demonstrated to be effective and safe. 14 The current authors suspect that because the mechanism of injury is classically a "low energy fall," 4 , 5 the likelihood of signifi cant softtissue damage occurring in association with such a fracture is minimal. To date, little biomechanical literature has examined the stability of an odontoid fracture, 11 and no known literature has examined the effect of specifi c soft-tissue disruption in addition to this fracture.…”

The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

“…Odontoid fractures account for 9-18 % of all cervical spine fractures and are most frequently caused by either hyperextension or hyperflexion [5,14,20,22,34,37]. In the elderly, odontoid fractures are the most common cervical spine fractures [17,18,20,22,29,30,35].…”