European Spine Journal

, Volume 19, Issue 10, pp 1635–1642 | Cite as

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

  • J. S. ButlerEmail author
  • R. T. Dolan
  • M. Burbridge
  • C. J. Hurson
  • J. M. O’Byrne
  • D. McCormack
  • K. Synnott
  • A. R. Poynton
Original Article


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.


Cervical spine Odontoid fracture Non-operative Functional outcome 


  1. 1.
    Lee PC, Chun SY, Leong JC (1984) Experience of posterior surgery in atlanto-axial instability. Spine 9:231–239CrossRefPubMedGoogle Scholar
  2. 2.
    Subach BR, Morone MA, Haid RW Jr et al (1999) Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery 45:812–819CrossRefPubMedGoogle Scholar
  3. 3.
    Vaccaro AR, Madigan L, Ehrler DM (2000) Contemporary management of adult cervical odontoid fractures. Orthopedics 23:1109–1113PubMedGoogle Scholar
  4. 4.
    Maak TG, Grauer JN (2006) The contemporary treatment of odontoid injuries. Spine 31(11):53–60CrossRefGoogle Scholar
  5. 5.
    Clark CR, White AA 3rd (1985) Fractures of the dens. A multicenter study. J Bone Joint Surg Am 67(9):1340–1348PubMedGoogle Scholar
  6. 6.
    Greene KA, Dickman CA, Marciano FF et al (1994) Transverse atlantal ligament disruption associated with odontoid fractures. Spine 19(20):2307–2314PubMedGoogle Scholar
  7. 7.
    Müller EJ, Wick M, Russe O et al (1999) Management of odontoid fractures in the elderly. Eur Spine J 8(5):365–369Google Scholar
  8. 8.
    Ochoa G (2005) Surgical management of odontoid fractures. Injury 36:S-B54–S-B64CrossRefGoogle Scholar
  9. 9.
    Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56(8):1663–1674PubMedGoogle Scholar
  10. 10.
    BenDebba M, Heller J, Ducker TB, Eisinger JM (2002) Cervical spine outcomes questionnaire: its development and psychometric properties. Spine 27(19):2116–2123 (discussion 2124)CrossRefPubMedGoogle Scholar
  11. 11.
    Müller EJ, Schwinnen I, Fisher K, Wick M, Muhr G (2003) Non-rigid immobilization of odontoid fractures. Eur Spine J 12:522–525CrossRefPubMedGoogle Scholar
  12. 12.
    Sasso RC (2001) C2 dens fractures: treatment options. J Spinal Disord 14(5):455–463CrossRefPubMedGoogle Scholar
  13. 13.
    Ekong CEU, Schwartz ML, Tator CH, Rowed DW, Edmonds VE (1981) Odontoid fracture: management with early mobilisation using the halo device. Neurosurgery 9:631–637CrossRefPubMedGoogle Scholar
  14. 14.
    Garfin SR, Botte MJ, Waters RL, Nickel VL (1986) Complications in the use of the halo fixation device. J Bone Joint Surg Am 69:320–325Google Scholar
  15. 15.
    Schweigel JF (1987) Management of the fractured odontoid with halo-thoracic bracing. Spine 12:838–839CrossRefPubMedGoogle Scholar
  16. 16.
    Lind B, Nordwall A, Sihlbom H (1987) Odontoid fractures treated with halovest. Spine 12:173–177CrossRefPubMedGoogle Scholar
  17. 17.
    Ryan MD, Henderson JJ (1992) The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury 23:38–40CrossRefPubMedGoogle Scholar
  18. 18.
    Seybold EA, Bayley JC (1998) Functional outcome of surgically and conservatively managed dens fractures. Spine 23(17):1837–1846CrossRefPubMedGoogle Scholar
  19. 19.
    Bednar DA, Parikh J, Hummel J (1995) Management of type II odontoid process fractures in geriatric patients: a prospective study of sequential cohorts with attention to survivorship. J Spinal Disord 8(2):166–169CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • J. S. Butler
    • 1
    • 2
    Email author
  • R. T. Dolan
    • 3
  • M. Burbridge
    • 1
  • C. J. Hurson
    • 1
  • J. M. O’Byrne
    • 2
  • D. McCormack
    • 1
  • K. Synnott
    • 1
  • A. R. Poynton
    • 1
  1. 1.National Spinal Injuries Unit, Department of Trauma and Orthopaedic SurgeryMater Misericordiae University HospitalDublin 7Ireland
  2. 2.Department of Trauma and Orthopaedic Surgery, Royal College of Surgeons in IrelandCappagh National Orthopaedic HospitalDublin 11Ireland
  3. 3.UCD School of Medicine and Medical ScienceUniversity College DublinDublin 4Ireland

Personalised recommendations