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Odontoid Process Fractures

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Reconstruction of Upper Cervical Spine and Craniovertebral Junction

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Abstract

Fractures of the C2 odontoid process are the most frequent injuries of the upper cervical spine (UCS). The majority of them are located at the base of the process (Type II). Less frequently, the fracture line passes through the C2 body (Type III) and exceptionally it remains above the transverse ligament (Type I). Contemporary treatment of choice in type II and shallow type III fractures is direct compressive osteosynthesis with one or two screws. However, other treatment modalities can be used to treat certain types of Type II fractures. Odontoid tip abruptions and broadbased odontoid-C2 body fractures are, usually, successfully treated with external bracing.

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References

  1. Aebi, M.: Surgical treatment of upper, middle and lower cervical injuries and non-unions by anterior procedures. Eur Spine J 19(Suppl 1), S33–S39 (2009)

    PubMed  Google Scholar 

  2. Aebi, M., Etter, C., Coscia, M.: Fractures of the odontoid process. Treatment with anterior screw fixation. Spine (Phila Pa 1976) 14, 1065–1070 (1989)

    CAS  Google Scholar 

  3. Althoff, B.: Fracture of the odontoid process. An experimental and clinical study. Acta Orthop Scand Suppl 177, 1–95 (1979)

    CAS  PubMed  Google Scholar 

  4. Althoff, B., Goldie, I.F.: The arterial supply of the odontoid process of the axis. Acta Orthop Scand 48, 622–629 (1977)

    Article  CAS  PubMed  Google Scholar 

  5. Amling, M., Posl, M., Wening, V.J., et al.: Structural heterogeneity within the axis: the main cause in the etiology of dens fractures. A histomorphometric analysis of 37 normal and osteoporotic autopsy cases. J Neurosurg 83, 330–335 (1995)

    Article  CAS  PubMed  Google Scholar 

  6. Anderson, L.D., D’Alonzo, R.T.: Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56, 1663–1674 (1974)

    CAS  PubMed  Google Scholar 

  7. Anonymous: Isolated fractures of the axis in adults. Neurosurgery 50, S125–S139 (2002)

    Article  Google Scholar 

  8. Apfelbaum, R.I., Lonser, R.R., Veres, R., et al.: Direct anterior screw fixation for recent and remote odontoid fractures. Neurosurg Focus 8, 1–10 (2000)

    Article  Google Scholar 

  9. Apuzzo, M.L., Heiden, J.S., Weiss, M.H., et al.: Acute fractures of the odontoid process. An analysis of 45 cases. J Neurosurg 48, 85–91 (1978)

    Article  CAS  PubMed  Google Scholar 

  10. Bohler, J.: Anterior stabilization for acute fractures and non-unions of the dens. J Bone Joint Surg Am 64, 18–27 (1982)

    CAS  PubMed  Google Scholar 

  11. Bohlman, H.H.: Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am 61, 1119–1142 (1979)

    CAS  PubMed  Google Scholar 

  12. Brooks, A.L., Jenkins, E.B.: Atlanto-axial arthrodesis by the wedge compression method. J Bone Joint Surg Am 60, 279–284 (1978)

    CAS  PubMed  Google Scholar 

  13. Bucholz, R.W.: Unstable hangman’s fractures. Clin Orthop Relat Res 154, 119–124 (1981)

    PubMed  Google Scholar 

  14. Campanelli, M., Kattner, K.A., Stroink, A., et al.: Posterior C1-C2 transarticular screw fixation in the treatment of displaced type II odontoid fractures in the geriatric population – review of seven cases. Surg Neurol 51, 596–600 (1999). discussion 600–591

    Article  CAS  PubMed  Google Scholar 

  15. Chiba, K., Fujimura, Y., Toyama, Y., et al.: Treatment protocol for fractures of the odontoid process. J Spinal Disord 9, 267–276 (1996)

    Article  CAS  PubMed  Google Scholar 

  16. Clark, C.R., White 3rd, A.A.: Fractures of the dens. A multicenter study. J Bone Joint Surg Am 67, 1340–1348 (1985)

    CAS  PubMed  Google Scholar 

  17. Coyne, T.J., Fehlings, M.G., Wallace, M.C., et al.: C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery 37, 688–692 (1995). discussion 692–683

    Article  CAS  PubMed  Google Scholar 

  18. Dailey, A.T., Hart, D., Finn, M.A., et al.: Anterior fixation of odontoid fractures in an elderly population. J Neurosurg Spine 12, 1–8 (2010)

    Article  PubMed  Google Scholar 

  19. de Mourgues, G., Fischer, L., Comtet, J.J., et al.: Fractures of the odontoid process of the axis: a series of 80 fractures. Acta Orthop Belg 38, 137–146 (1972)

    PubMed  Google Scholar 

  20. Dickman, C.A., Mamourian, A., Sonntag, V.K., et al.: Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 75, 221–227 (1991)

    Article  CAS  PubMed  Google Scholar 

  21. Dickman, C.A., Sonntag, V.K.: Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery 43, 275–280 (1998). discussion 280–271

    Article  CAS  PubMed  Google Scholar 

  22. Dickman, C.A., Sonntag, V.K., Papadopoulos, S.M., et al.: The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74, 190–198 (1991)

    Article  CAS  PubMed  Google Scholar 

  23. Dunn, M.E., Seljeskog, E.L.: Experience in the management of odontoid process injuries: an analysis of 128 cases. Neurosurgery 18, 306–310 (1986)

    Article  CAS  PubMed  Google Scholar 

  24. Estridge, M.N., Smith, R.A.: Transoral fusion of odontoid fracture. Case report. J Neurosurg 27, 462–465 (1967)

    Article  CAS  PubMed  Google Scholar 

  25. Fang, H.S.Y., Ong, G.B.: Direct anterior approach to the upper cervical spine. J Bone Joint Surg Am 44, 1588–1604 (1962)

    Google Scholar 

  26. Fountas, K.N., Kapsalaki, E.Z., Karampelas, I., et al.: Results of long-term follow-up in patients undergoing anterior screw fixation for type II and rostral type III odontoid fractures. Spine (Phila Pa 1976) 30, 661–669 (2005)

    Google Scholar 

  27. Frangen, T.M., Zilkens, C., Muhr, G., et al.: Odontoid fractures in the elderly: dorsal C1/C2 fusion is superior to halo-vest immobilization. J Trauma 63, 83–89 (2007)

    Article  PubMed  Google Scholar 

  28. Fujii, E., Kobayashi, K., Hirabayashi, K.: Treatment in fractures of the odontoid process. Spine (Phila Pa 1976) 13, 604–609 (1988)

    CAS  Google Scholar 

  29. Gallie, W.E.: Fractures and dislocations of the cervical spine. Am J Surg 46, 495–499 (1939)

    Article  Google Scholar 

  30. Geisler, F.H., Cheng, C., Poka, A., et al.: Anterior screw fixation of posteriorly displaced type II odontoid fractures. Neurosurgery 25, 30–37 (1989). discussion 37–38

    Article  CAS  PubMed  Google Scholar 

  31. Gluf, W.M., Schmidt, M.H., Apfelbaum, R.I.: Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine 2, 155–163 (2005)

    Article  PubMed  Google Scholar 

  32. Goel, A., Laheri, V.: Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129, 47–53 (1994)

    Article  CAS  Google Scholar 

  33. Govender, S., Grootboom, M.: Fractures of the dens – the results of non-rigid immobilization. Injury 19, 165–167 (1988)

    Article  CAS  PubMed  Google Scholar 

  34. Grauer, J.N., Shafi, B., Hilibrand, A.S., et al.: Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J 5, 123–129 (2005)

    Article  PubMed  Google Scholar 

  35. Graziano, G., Jaggers, C., Lee, M., et al.: A comparative study of fixation techniques for type II fractures of the odontoid process. Spine (Phila Pa 1976) 18, 2383–2387 (1993)

    CAS  Google Scholar 

  36. Greene, K.A., Dickman, C.A., Marciano, F.F., et al.: Acute axis fractures. Analysis of management and outcome in 340 consecutive cases. Spine (Phila Pa 1976) 22, 1843–1852 (1997)

    CAS  Google Scholar 

  37. Griswold, D.M., Albright, J.A., Schiffman, E., et al.: Atlanto-axial fusion for instability. J Bone Joint Surg Am 60, 285–292 (1978)

    CAS  PubMed  Google Scholar 

  38. Grob, D., Jeanneret, B., Aebi, M., et al.: Atlanto-axial fusion with transarticular screw fixation. J Bone Joint Surg Br 73, 972–976 (1991)

    CAS  PubMed  Google Scholar 

  39. Grob, D., Magerl, F.: Operative stabilisierung bei frakturen von C1 und C2. Orthopäde 16, 46–54 (1987)

    CAS  PubMed  Google Scholar 

  40. Hadley, M.N., Browner, C.M., Liu, S.S., et al.: New subtype of acute odontoid fractures (type IIA). Neurosurgery 22, 67–71 (1988)

    CAS  PubMed  Google Scholar 

  41. Hadley, M.N., Browner, C., Sonntag, V.K.: Axis fractures: a comprehensive review of management and treatment in 107 cases. Neurosurgery 17, 281–290 (1985)

    Article  CAS  PubMed  Google Scholar 

  42. Hadley, M.N., Dickman, C.A., Browner, C.M., et al.: Acute axis fractures: a review of 229 cases. J Neurosurg 71, 642–647 (1989)

    Article  CAS  PubMed  Google Scholar 

  43. Hanigan, W.C., Powell, F.C., Elwood, P.W., et al.: Odontoid fractures in elderly patients. J Neurosurg 78, 32–35 (1993)

    Article  CAS  PubMed  Google Scholar 

  44. Harms, J., Melcher, R.P.: Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26, 2467–2471 (2001)

    CAS  Google Scholar 

  45. Hashizume, H., Kawakami, M., Kawai, M., et al.: A clinical case of endoscopically assisted anterior screw fixation for the type II odontoid fracture. Spine (Phila Pa 1976) 28, E102–E105 (2003)

    Google Scholar 

  46. Holdsworth, F.: Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am 52, 1534–1551 (1970)

    CAS  PubMed  Google Scholar 

  47. Horn, E.M., Theodore, N., Feiz-Erfan, I., et al.: Complications of halo fixation in the elderly. J Neurosurg Spine 5, 46–49 (2006)

    Article  PubMed  Google Scholar 

  48. Hrabalek, L., Burval, S., Vaverka, M.: Anterior osteosynthesis of odontoid fractures. Acta Chir Orthop Traumatol Cech 75, 332–338 (2008)

    CAS  PubMed  Google Scholar 

  49. Jeanneret, B., Magerl, F.: Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 5, 464–475 (1992)

    Article  CAS  PubMed  Google Scholar 

  50. Jenkins, J.D., Coric, D., Branch Jr., C.L.: A clinical comparison of one- and two-screw odontoid fixation. J Neurosurg 89, 366–370 (1998)

    Article  CAS  PubMed  Google Scholar 

  51. Johnson, J.E., Yang, P.J., Seeger, J.F., et al.: Vertical fracture of the odontoid: CT diagnosis. J Comput Assist Tomogr 10, 311–312 (1986)

    Article  CAS  PubMed  Google Scholar 

  52. Julien, T.D., Frankel, B., Traynelis, V.C., et al.: Evidence-based analysis of odontoid fracture management. Neurosurg Focus 8, e1 (2000)

    Article  CAS  PubMed  Google Scholar 

  53. Knöringer, P.: Internal fixation of dens fractures by double-threaded screws. Orthoped Traumatol 4, 231–245 (1992)

    Article  Google Scholar 

  54. Koivikko, M.P., Kiuru, M.J., Koskinen, S.K., et al.: Factors associated with nonunion in conservatively-treated type-II fractures of the odontoid process. J Bone Joint Surg Br 86, 1146–1151 (2004)

    Article  CAS  PubMed  Google Scholar 

  55. Koller, H., Zenner, J., Hitzl, W., et al.: In vivo analysis of atlantoaxial motion in individuals immobilized with the halo thoracic vest or Philadelphia collar. Spine (Phila Pa 1976) 34, 670–679 (2009)

    Google Scholar 

  56. Lambotte, A.: L’Intervention Operatoire dans Les Fractures Recentes et Anciennes. In: Relter, R.F. (ed.) Fractures. Henri Lamertin, Brussels (1907)

    Google Scholar 

  57. Lennarson, P.J., Mostafavi, H., Traynelis, V.C., et al.: Management of type II dens fractures: a case-control study. Spine (Phila Pa 1976) 25, 1234–1237 (2000)

    CAS  Google Scholar 

  58. Maak, T.G., Grauer, J.N.: The contemporary treatment of odontoid injuries. Spine (Phila Pa 1976) 31, S53–S60 (2006). discussion S61

    Google Scholar 

  59. Magerl, F., Seemann, P.S.: Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr, P., Weidner, A. (eds.) Cervical spine, pp. 322–327. Springer, Wien (1987)

    Google Scholar 

  60. Marcotte, P., Dickman, C.A., Sonntag, V.K., et al.: Posterior atlantoaxial facet screw fixation. J Neurosurg 79, 234–237 (1993)

    Article  CAS  PubMed  Google Scholar 

  61. Mixter, S.J., Osgood, R.B.: IV. Traumatic lesions of the atlas and axis. Ann Surg 51, 193–207 (1910)

    Article  CAS  PubMed  Google Scholar 

  62. Montesano, P.X., Anderson, P.A., Schlehr, F., et al.: Odontoid fractures treated by anterior odontoid screw fixation. Spine (Phila Pa 1976) 16, S33 (1991)

    CAS  Google Scholar 

  63. Muller, E.J., Schwinnen, I., Fischer, K., et al.: Non-rigid immobilisation of odontoid fractures. Eur Spine J 12, 522–525 (2003)

    Article  PubMed  Google Scholar 

  64. Muller, E.J., Wick, M., Russe, O., et al.: Management of odontoid fractures in the elderly. Eur Spine J 8, 360–365 (1999)

    Article  CAS  PubMed  Google Scholar 

  65. Nakanishi, K., Sasaki, T., Tokita, N., et al.: Internal fixation for the odontoid fracture. Orthop Trans 6, 176 (1982)

    Google Scholar 

  66. Nourbakhsh, A., Shi, R., Vannemreddy, P., et al.: Operative versus nonoperative management of acute odontoid Type II fractures: a meta-analysis. J Neurosurg Spine 11, 651–658 (2009)

    PubMed  Google Scholar 

  67. Omeis, I., Duggal, N., Rubano, J., et al.: Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis. J Spinal Disord Tech 22, 91–95 (2009)

    Article  PubMed  Google Scholar 

  68. Platzer, P., Thalhammer, G., Krumboeck, A., et al.: Plate fixation of odontoid fractures without C1-C2 arthrodesis: practice of a novel surgical technique for stabilization of odontoid fractures, including the opportunity to extend the fixation to C3. Neurosurgery 64, 726–733 (2009). discussion 733

    Article  PubMed  Google Scholar 

  69. Platzer, P., Thalhammer, G., Sarahrudi, K., et al.: Nonoperative management of odontoid fractures using a halothoracic vest. Neurosurgery 61, 522–529 (2007). discussion 529–530

    Article  PubMed  Google Scholar 

  70. Polin, R.S., Szabo, T., Bogaev, C.A., et al.: Nonoperative management of Types II and III odontoid fractures: the Philadelphia collar versus the halo vest. Neurosurgery 38, 450–456 (1996). discussion 456–457

    Article  CAS  PubMed  Google Scholar 

  71. Pratt, H., Davies, E., King, L.: Traumatic injuries of the c1/c2 complex: computed tomographic imaging appearances. Curr Probl Diagn Radiol 37, 26–38 (2008)

    Article  PubMed  Google Scholar 

  72. Roy-Camille, R., de la Caffiniére, J.H., Saillant, G.: Les traumatismes du rachis cervical superieur C1-C2. Masson et Cie, Paris (1973)

    Google Scholar 

  73. Ryan, M.D., Henderson, J.J.: The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury 23, 38–40 (1992)

    Article  CAS  PubMed  Google Scholar 

  74. Ryan, M.D., Taylor, T.K.: Odontoid fractures. A rational approach to treatment. J Bone Joint Surg Br 64, 416–421 (1982)

    CAS  PubMed  Google Scholar 

  75. Ryan, M.D., Taylor, T.K.: Odontoid fractures in the elderly. J Spinal Disord 6, 397–401 (1993)

    Article  CAS  PubMed  Google Scholar 

  76. Saeed, M.U., Dacuycuy, M.A., Kennedy, D.J.: Halo pin insertion-associated brain abscess: case report and review of literature. Spine (Phila Pa 1976) 32, E271–E274 (2007)

    Google Scholar 

  77. Sandler, A.J., Dvorak, J., Humke, T., et al.: The effectiveness of various cervical orthoses. An in vivo comparison of the mechanical stability provided by several widely used models. Spine (Phila Pa 1976) 21, 1624–1629 (1996)

    CAS  Google Scholar 

  78. Sasso, R., Doherty, B.J., Crawford, M.J., et al.: Biomechanics of odontoid fracture fixation. Comparison of the one- and two-screw technique. Spine (Phila Pa 1976) 18, 1950–1953 (1993)

    CAS  Google Scholar 

  79. Saur, K., Sames, M.: Results of the treatment of odontoid fractures by osteosynthesis with a single axial screw. Acta Chir Orthop Traumatol Cech 75, 48–51 (2008)

    CAS  PubMed  Google Scholar 

  80. Schatzker, J., Rorabeck, C.H., Waddell, J.P.: Fractures of the dens (odontoid process). An analysis of thirty-seven cases. J Bone Joint Surg Br 53, 392–405 (1971)

    CAS  PubMed  Google Scholar 

  81. Schatzker, J., Rorabeck, C.H., Waddell, J.P.: Non-union of the odontoid process. An experimental investigation. Clin Orthop Relat Res 108, 127–137 (1975)

    Article  PubMed  Google Scholar 

  82. Schneider, A.M., Hipp, J.A., Nguyen, L., et al.: Reduction in head and intervertebral motion provided by 7 contemporary cervical orthoses in 45 individuals. Spine (Phila Pa 1976) 32, E1–E6 (2007)

    Google Scholar 

  83. Scott, E.W., Haid Jr., R.W., Peace, D.: Type I fractures of the odontoid process: implications for atlanto-occipital instability. Case report. Neurosurg 72, 488–492 (1990)

    Article  CAS  Google Scholar 

  84. Seybold, E.A., Bayley, J.C.: Functional outcome of surgically and conservatively managed dens fractures. Spine (Phila Pa 1976) 23, 1837–1845 (1998). discussion 1845–1836

    CAS  Google Scholar 

  85. Shalayev, S.G., Mun, I.K., Mallek, G.S., et al.: Retrospective analysis and modifications of retractor systems for anterior odontoid screw fixation. Neurosurg Focus 16, 1–4 (2004)

    Article  Google Scholar 

  86. Streli, R.: Kompressionosteosynthese bei Fracturen und Pseudoarthrosen des Dens Epistrophei. Z Orthop 119, 675–676 (1981)

    Google Scholar 

  87. Strohm, P.C., Muller Ch, A., Kostler, W., et al.: Halo-fixator vest – indications and complications. Zentralbl Chir 132, 54–59 (2007)

    Article  CAS  PubMed  Google Scholar 

  88. Stulik, J., Suchomel, P., Lukas, R., et al.: Primary osteosynthesis of the odontoid process: a multicenter study. Acta Chir Orthop Traumatol Cech 69, 141–148 (2002)

    CAS  PubMed  Google Scholar 

  89. Subach, B.R., Morone, M.A., Haid Jr., R.W., et al.: Management of acute odontoid fractures with single-screw anterior fixation. Neurosurgery 45, 812–819 (1999). discussion 819–820

    Article  CAS  PubMed  Google Scholar 

  90. Suchomel, P.: Analysis of the causes of failure in the treatment of simple traumatic epidural hematomas. Rozhl Chir 69, 649–654 (1990)

    CAS  PubMed  Google Scholar 

  91. Suchomel, P., Taller, S., Lukas, R., et al.: Surgical treatment of fractures of the odontoid process. Rozhl Chir 79, 301–308 (2000)

    CAS  PubMed  Google Scholar 

  92. Tashjian, R.Z., Majercik, S., Biffl, W.L., et al.: Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures. J Trauma 60, 199–203 (2006)

    Article  PubMed  Google Scholar 

  93. Tippets, R.H., Alvis, M.A.: Treatment of axis fractures. In: Menezes, A.H., Sonntag, V.K.H. (eds.) Principles of spinal surgery, pp. 871–883. McGraw-Hill, New York (1996)

    Google Scholar 

  94. Traynelis, V.C.: Evidence-based management of type II odontoid fractures. Clin Neurosurg 44, 41–49 (1997)

    CAS  PubMed  Google Scholar 

  95. Waddell, J.P., Reardon, G.P.: Atlantoaxial arthrodesis to treat odontoid fractures. Can J Surg 26(255–257), 260 (1983)

    Google Scholar 

  96. Weller, S.J., Malek, A.M., Rossitch Jr., E.: Cervical spine fractures in the elderly. Surg Neurol 47, 274–280 (1997). discussion 280–271

    Article  CAS  PubMed  Google Scholar 

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  1. Department of Neurosurgery, Neurocenter, Regional Hospital Liberec, Husova st. 10, 46063, Liberec, Czech Republic

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Suchomel, P., Jurák, L. (2011). Odontoid Process Fractures. In: Reconstruction of Upper Cervical Spine and Craniovertebral Junction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-13158-5_11

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