In odontoid fractures, surgical stability can be achieved by either fracture fixation of the C2 body to the odontoid process or by arthrodesis of the C1-C2 motion segment. Which vertebrae has odontoid process? Odontoid fracture accounts for approximately 20% of all cervical spine injuries. Discuss the importance of interprofessional team strategies for improving care coordination and communication to aid in prompt diagnosis of C2 odontoid fracture and improving outcomes in patients diagnosed with the condition. Molinari et al. Case descriptions Limitation of the Study Type II fractures can be managed conservatively or surgically. A type 2B is displaced and is generally treated with anterior screw fixation. Abstract and Figures Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. INTRODUCTION. The patient was diagnosed with a type II odontoid fracture. Additionally, Type II fractures are often the least stable of the odontoid fractures; therefore physicians use further classification categories for Type II fractures (A, B, and C types). Sometimes, type II fracture is associated with a comminuted fragment at the base of the dens called the type II A variety of fracture; this fracture is markedly unstable. The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. Dens. | Find, read and cite all the research you . On its anterior surface is an oval or nearly . One patient required early stabilization because alignment could not be maintained in a halo vest, and the second patient required late stabilization for nonunion after a 3-month period of immobilization in a two-poster cervical brace. Odontoid fractures constitute the most common cervical fractures in elderly. External immobilization is the treatment of choice for Type I and III; there is still no wide consensus about the best management of Type II fractures. Pathology The mechanism of injury is variable, and can occur both during flexion or extension, and with or without compression 5. It is called a type 2 odontoid fracture. Type II in elderly who are not surgical candidates union is unlikely, however a fibrous union should provide sufficient stability except in the case of major trauma Type III no evidence to support Halo over hard collar technique typically worn for 6-12 weeks halo immobilization indications Type II young patient with no risk factors for nonunion Summarize the treatment and management strategies available for C2 odontoid fractures, based on the specific fracture type. There is a subdivision of type 2 fractures. This is an avulsion injury to the tip of the odontoid and usually is stable. It is the most common type of fracture in this area. Abstract. . 2 Among combined injuries of the cervical spine, rotational atlantoaxial subluxation with type II dens fracture were reported in . 19 Present treatment options include external fi xation with the halo-vest or collar, or internal fi xation . Among all cervical fractures, type II odontoid fractures are 66% that are mainly due to high energy trauma, for example motorbike accidents. There is concern about the placement of the odontoid screw in the elderly population and instances of delayed non-union. Nonsurgical measures include immobilization, prevent or restrict movement, in a cervical collar or halo vest. Surgery. Is type 2 odontoid fracture unstable? What is Type 2 Odontoid fracture? Odontoid fractures. This type of fracture occasionally is associated with gross instability due to traction forces applied to, and subsequent injury of, the apical and/or alar ligaments. Type II Odontoid Fractures of the Cervical Spine Published in final edited form as: , 10, 24 To the best of our knowledge, this series represents one of the larger studies investigating mortality in patients aged 65 years and older with Type II odontoid fractures and midrange follow-up. It is a quick and safe, motion preserving technique to stabilize these fractures. Internal fixation (odontoid screw fixation) [ 11] 13. After a systematic . The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical . Hypertrophic nonunion of Type II odontoid fractures occur rarely as a cause of progressive cervical myelopathy and requires different management inclusive of spinal cord decompression than that advocated for more straightforward atrophic nonunion in which realignment and stabilization may be the primary surgical objectives. Case series PDF | Introduction Among all cervical fractures, type II odontoid fractures are 66% that are mainly due to high energy trauma, for example motorbike. Cervical spine imaging revealed an old sclerotic type II dens fracture with anterolisthesis of C1 over C2, resulting in severe compression of the spinal cord with high T2 cord signal at the cervicomedullary junction. Patient Selection Criteria. The dens, also called the odontoid process or the peg, is the most pronounced projecting feature of the axis.The dens exhibits a slight constriction where it joins the main body of the vertebra. In one study, fusion surgery done through the back of the neck proved to be 100 percent successful within six months. Odontoid fractures are relatively common fractures of the C2 vertebral body (axis) that can be seen in low energy falls in eldery patients and high energy traumatic injuries in younger patients. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. Eur Spine J 2013, 22(1):1-13. The fracture line involves the junction of the body of the dens with the body of the axis. A type I fracture (< 5% of cases) is an oblique fracture through the upper part of the odontoid process. Much of the morbidity of type II geriatric odontoid fractures has traditionally been thought to be due to the risk of non-healing; thus, radiological osseous union has been used to determine the optimal treatment outcome [ 2, 3 ]. Type II: A Fracture at the base of the dens. You can nod, shake, tilt, and turn your head all done as the skull moves around the pivot point of the upper cervical spine. The Odontoid process is a projection of the axis, a second cervical vertebra, and joins the main body . A type II odontoid fracture extends through the base of the dens. This injury is associated with a high incidence of morbidity, mortality and nonunion in the elderly irrespective of mode of treatment. Treatment options include the following: Halo immobilization. The condition where the dens is separated from the body of the axis is called os odontoideum and may cause nerve and circulation compression syndrome. There are varied management approaches with paucity of robust evidence to guide. A stable fracture may "set" and heal itself. A Biblioteca Virtual em Sade uma colecao de fontes de informacao cientfica e tcnica em sade organizada e armazenada em formato eletrnico nos pases da Regio Latino-Americana e do Caribe, acessveis de forma universal na Internet de modo compatvel com as bases internacionais. Type III odontoid fracture treatment In general, the Type III odontoid fracture is believed to have high healing potential due to the large fracture surface area through cancellous bone . This makes them the most likely to require surgery. Bones of the spine are called vertebrae. 19, 23 Many articles in the past have documented nonsurgical treatment by external immobilization, with reported nonunion . We treated 22 patients with type-two odontoid fractures in halothoracic vests for six to eight weeks followed by a Philadelphia collar for four weeks. For surgery, there are two acceptable methods; anterior odontoid screw fixation (AOSF) and posterior cervical instrumented fusion (PCIF). The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. Mean follow-up was 32 (44) weeks. Odontoid fractures type II according to Anderson and d'Alonzo are not uncommon in the elderly patients. Observational multicenter study was conducted on a prospectively built database on elderly patients (> 75 years) with Type II odontoid fracture managed conservatively . How do you fracture your odontoid? Lateral subluxation of the atlas (C1) and axis (C2) associated with type II odontoid fracture of the dens is very rare. The joint between C2 and the vertebra above, C1, has an outstanding range of motion. Fractures of the dens, however, are the most common injury to the C2 vertebra. Nonoperative management of fractures in the setting of diffuse idiopathic skeletal hyperostosis (DISH) or ankylosing spondylitis is often unsuccessful. Treatment for type I C2 (axis) fractures is hard-collar immobilization for 6-8 weeks, which usually is quite successful. Non- operative treatment is generally recommended for type I and type III fractures. Odontoid process fracture, also known as a peg or dens fracture , occurs where there is a fracture through the odontoid process of C2. A type 2A fracture is minimally displaced and is treated with external immobilisation. One 74-year-old patient (not . Fractures at the dens base, classified by the Anderson and D'Alonzo system as Type II injuries, are the most common pattern of all odontoid fractures and are also the most common cervical injuries in patients older than 70 years of age. This is the only spinal fixation technique for fractures that restores spinal stability yet completely preserves normal spinal motion. Two cases of simultaneous Jefferson fracture of C1 and Type II odontoid fracture requiring surgical stabilization are reported. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. performed a retrospective study of consecutive patients aged 65 years or older with Type II odontoid fracture (N = 322) and found that operative management resulted in statistically significantly improved 30-day survival but only a trend toward improved long-term mortality [5]. Patient selection in odontoid fracture care is critical. Type II fracture, the most common type of odontoid fracture, is considered relatively unstable. The joint between C2 and the vertebra above, C1, has an outstanding range of motion. Intraoperative Images Figure 4: Intraoperative AP (left) and lateral (right) fluoroscopy images showing the depth gauge. Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1-C2 fusion. Issues relating to fracture configuration, the size of the remaining "peg" in achieving distal fixation, the need for and ease of fracture reduction, and bone density are all variables to consider in the ability to properly place screw(s) with sufficient fixation to encourage fracture healing (Figures 1 and 2). Type II fractures, which occur at the base of the dens, are by far the most common odontoid fractures seen in clinical practice. Odontoid fractures were diagnosed by anteroposterior, lateral, and open mouth (atlantoaxial) X-rays, computed tomography (CT) scanning, three-dimensional (3-D CT) scanning, and magnetic resonance imaging (MRI). Treatment depends on the location of the fracture within the C2 vertebrae defined by the Anderson and D'Alonzo classification system and the patient's risk factors for nonunion (failed bone healing). Always check the coronal view, which more readily demonstrates the relationship of the fracture to the VB. Odontoid screw fixation is the preferred method for stabilization of acute, unstable Type II odontoid fractures. after scrolling through 394,260 articles pertaining to odontoid fractures, no evidence based management algorithm can be proposed [ 52 ]. 1) Hanssen AD . Treatment may take the form of surgery or wearing a brace. Odontoid fractures typically occur as a result of trauma: high-velocity injuries like motor vehicle accidents in young people and falls for the elderly. According to the Anderson and D'Alonso classification, type II odontoid fracture, the commonest type, is unstable and vulnerable to nonunion 1. Type III: A fracture occurring in the body of the axis underlying the dens. of type II and III odontoid fractures in the elderly: a systematic review. Thirty-three patients met the inclusion and exclusion criteria including 15 patients treated in a halo vest and 18 in a hard collar orthosis. A fracture of the odontoid process (dens) can create instability of the head on the spine. The odontoid screw was partially threaded. Type 2 odontoid process fracture Case Discussion This case demonstrates a type 2 odontoid process fracture, a transverse fracture through the base of the dens and represents the most common type of dens fracture. There were 9 type II and 3 shallow type III fractures according to the classification of Anderson and D'Alonzo [ 11 ]. Type II fractures are considered the least stable of the odontoid fractures. Flexion-extension cervical spine x-rays showed atlanto-dental interval (ADI) of 14mm on flexion that reduced to 4mm on extension. Treatment options for type II odontoid fractures can be nonsurgical or surgical. However, spinal cord transections are rare with these types of . Type II is the commonest type of dens fracture. Chapman et al. It occurs at the base of the odontoid between the level of the transverse ligament and the C2 vertebral body. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. The bone involved in odontoid fracture is the second vertebra, C2, high up in the neck. Anterior cannulated screw fixation is the preferred technique for type II B Odontoid fractures in the elderly patient. See Atlantoaxial fusion (C1-2 arthrodesis) and Anterior odontoid screw fixation for surgical options and operative details. A type III odontoid fracture may be misinterpreted as odontoid fracture type II on sagittal CT because the fracture may appear to lie above the vertebral body ( VB ). These are called odontoid fractures and this particular one is the more difficult type to treat. Some authors instead consider a stable non-union an acceptable result in the elderly [ 3, 4 ]. Methods:We retrospectively performed a chart review of patients over 65 years of age who underwent odontoid screw placement for type II odontoid fractures (2009-2014) and sustained post-operative . Bones of the spine are called vertebrae. Among the odontoid fracture, type-2 fracture is the most common variety. The odontoid process is a bony protusion upwards off the vertebral body of C2. Type II odontoid fractures occur when the cervical spine is hyperflexed (bent severely backward) or hyperextended (bent severely forward). In an unstable fracture, the bone is more likely to move out of its normal position and alignment. Odontoid fractures account for approximately 20% of all fractures of the cervical spine [1, 2].They represent the most common fractures of the cervical spine for patients older than 70 years and are the most common of all spinal fractures for patients older than 80 years [].As a result of demographic developments toward an older population, the incidence of this injury will further increase in . Posterior C1 to C2 transarticular screws C1 lateral mass and C2 pedicle screws A number of complications associated with this procedure have. It can be caused by either hyper-flexion or hyperextension mechanisms of injury. One hundred and twenty-five Type III odontoid fractures were identified with 51% classified as complex fractures. It is associated with excellent clinical results and a high rate of fusion. reported that only 33% of geriatric patients with type 2 odontoid fractures healed the fracture after posterior fusion surgery. Background:Although surgery may reduce mortality rates from type II odontoid fractures in the elderly population, post-operative dysphagia resulting from screw fixation remains a serious complication. Odontoid fractures are the most common cervical spine fractures in patients over 65, with type II being the most common. Many treatment options including hard collars, halovests and several surgical procedures, have been tried. Selected Treatment The patient had anterior odontoid screw fixation using 1 screw. Twenty percent of these fractures are odontoid fractures (OFx) of cervical vertebra 2 (C2) [].The incidence of this injury increases with age, making OFx the most common CS-fx in the elderly population [2,3,4].OFx are subdivided into types I, II and III according to the classification proposed by Anderson and D'Alonzo [].Type I fractures are very rare and do not require stabilization, while . Anterior screw fixation is a standard procedure for the surgical fixation of unstable type two odontoid fractures [ 3, 4 ]. The desire to maintain cervical motion is attractive, thus odontoid screw fixation has been increasingly reported. Odontoid fracture accounts for 15% - 20% of all cervical spine injuries. Dysphagia following ACSF is a common complication, which is usually transient. The subaxial spine is a common site of hypere. A type 2C is a fracture that extends from antero-inferior to postero-superior and is treated with instrumental fusion of C1 - C2. Posterior malunion with residual posterior displacement or angulation was associated with a higher incidence of persisting pain and the position at union did not correlate with the residual cervical stiffness. 47 In contrast to this work, the 73% fracture healing rate in our patients suggests that the likelihood of primary injury healing in elderly patients is fairly high. Hyperflexion and hyperextension can be caused by . In a recent work by Donnally et al. Surgery may be required if the fracture has resulted in neurologic symptoms and/or the spine has become unstable. Fractures of the odontoid present frequently in spinal trauma, and Type II odontoid fractures, occurring at the junction of the odontoid process and C2 vertebrae, represent the bulk of all . 1 Of these, type II fractures are the most prolific. Chapman J, Smith JS, Kopjar B: The AOSpine North America geriatric odontoid fracture mortality study: a retrospective review of mortality outcomes for operative versus non-operative treatment in 322 patients with long-term follow-up. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. Type II Fractures. A type II odontoid fracture is a break that occurs through a specific part of C2, the second bone in the neck. Type III fractures involve the lower portion of the C2 body at the C1 and C2 articulation. An odontoid screw can be placed for type-II odontoid fractures in good alignment with an intact transverse ligament in the acute setting. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon. Type I: Oblique avulsion fracture of tip of odontoid; alar ligament avulsion Stable fracture Type II: Fracture at base of odontoid where it meets C2 body Unstable fracture High risk of nonunion (30%) due to interruption of blood supply Type III: Extension of the fracture through upper portion of body of C2 Unstable fracture The C6 and C7 fractures were simple fractures of the back of the canal. Abstract Odontoid fractures comprise as many as 20% of all cervical spine fractures. Type I: A fracture of the upper part of the process (the tip.) Bones of the spine are called vertebrae. Type-2 odontoid fractures after decades of clinical research and development of different surgical strategies are still a management challenge. Classification There are two classification systems 5,6 Anderson and D'Alonzo How do you fix an Odontoid fracture? Odontoid fractures are classified into three types according to the fracture site: Type I: the fracture line traverses the odontoid tip above the transverse ligament, type II: the fracture line traverses the odontoid base (the most common type), and type III: fracture includes the body of C 2.Type I and III fractures are usually stable and do not need surgery but controversy remains about the . 22 They are generally believed to be unstable; however, controversy exists regarding optimal management of these injuries.
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