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PubMed1992

Intra-operative screw trimming in direct screw fixation of the odontoid process fracture--technical note.

For a satisfactory direct screw fixation of fractures of the odontoid process it is necessary to use a screw of the proper total length and thread length, but such an optimal ready-made screw is not always available. The authors describe a technique of intra-operative screw trimming using a high-speed diamond drill. This adjustment is easily and quickly performed. It enables the screw to act as a compression screw, which facilitates fusion of the fractured surfaces.

Bone Screws↗
PubMed1986

Experience in the management of odontoid process injuries: an analysis of 128 cases.

The authors present a retrospective analysis of 128 cases of odontoid process injury treated at the University of Minnesota and affiliated hospitals between the years 1967 and 1983. Of these 128 cases, 110 were acute fractures, while 18 patients suffered from old, unstable odontoid injuries. Motor vehicle accident was the leading cause of injury, and the largest group of patients was in their second decade. Type II fractures were the most commonly encountered type of injury, and anterior subluxation was the most common displacement. Posterior subluxation, however, had the highest incidence of associated neurological deficit. Regarding treatment, the 110 acute fracture patients fell into the following groups: 16 patients died during the acute phase, 14 patients underwent early posterior cervical fusion, and 80 patients underwent a course of external skeletal fixation. The remaining 18 patients with old unstable injuries underwent posterior cervical fusion. An analysis of the results in these groups led to the elucidation of certain factors that likely are important in determining the treatment of each individual patient. These factors include age of the patient, type of odontoid fracture, direction and degree of fracture displacement, and diagnostic delay. Fracture reduction and halo immobilization are the treatments preferred for patients who are diagnosed within 1 week of injury, who are less than 65 years of age and who have anteriorly, nondisplaced, or minimally posteriorly subluxed (less than 2 mm) Type II fractures, or who have any Type III injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1981

[Fracture of the odontoid process (author's transl)].

102 cases of fractures of the odontoid process have been seen by the author - 73 recent cases and 29 old ones. It was important to distinguish basal fractures (29 cases), which all united after conservative treatment by reduction and skull traction for six weeks followed by a plaster cast for six to eight weeks, and fractures of the body (44 cases). 41 body fractures were treated conservatively, of which 6 died and only 20 united. The authors consider that treatment by skull traction must always be tried. An eventual indication for surgery can be made at about the 20th day if displacement is found to be present in spite of treatment. Fusion in these cases must be limited to C1-C2. It is best obtained by a combination of wiring and grafting.

Adolescent↗
PubMed1994

Fractures of the odontoid process: analysis of the functional results after surgery.

Eighteen patients who sustained type II/III fractures of the odontoid process, as classified by Anderson and D'Alonzo [2], underwent anterior screw fixation, as described in detail by Böhler [4] as well as Grob and Magerl [16]. Follow-up investigations 3, 12 and in some cases up to 60 months later confirmed sufficient functional results regarding the mobility of the upper cervical spine. The passive mobility of the cervical spine was analyzed by the radiographic evaluation technique of Dvorak and co-workers [12] and Penning [26], which revealed a hypomobility of the C2-3 segment 1 year after surgery in 11 patients and a fusion of the C2-3 vertebral bodies in 2 cases. The postoperative results including the rate of complications were compared with other authors's findings and different therapy concepts (e.g., posterior C1-2 arthrodesis, halo-vest treatment).

Adolescent↗
PubMed1994

A new appraisal of abnormalities of the odontoid process associated with atlanto-axial subluxation and neurological disability.

It is well known that abnormalities of the odontoid process may be associated with subluxation and neuraxial compression. Modern computerized imaging is demonstrating that existing classifications are in need of revision since they no longer reflect current views on development, nor do they adequately explain the patterns of abnormality commonly encountered in clinical practice. This study is a description of 62 varied clinical cases examined by high definition computerized myelography or MRI in flexion and extension, some before and after stabilization procedures. From these descriptions, and a review of the old and more recent literature concerning phylogenesis and ontogenesis of the odontoid, the following conclusions were drawn. The dens within the atlas ring is not morphologically a centrum of the first cervical vertebra, but a projection arising from it. In os odontoideum the dens forms normally, but ossifies abnormally because of abnormal motion; it is a result rather than the cause of instability. Hypoplasia of the dens is usually incorrectly diagnosed. When present it is associated with atlanto-occipital assimilation, fusion of the second and third, or more, cervical vertebrae, loss or reduction in axial rotation of the head, basilar invagination and hindbrain deformity of Chiari type. Therefore it is part of a regional anomaly involving hypoplasia of the derivatives of the occipital and upper cervical somites. Recognition of these aspects simplifies both diagnosis and the formulation of therapeutic strategies for different types of clinical presentation.

Adolescent↗
PubMed1992

The signal intensity of the normal odontoid process (dens) displayed on magnetic resonance images.

In order to analyse the normal signal intensity of the medullary space of the odontoid process (dens) relative to age, the craniovertebral junction of 33 asymptomatic volunteers in six age groups was examined by means of magnetic resonance imaging. To avoid partial-volume effects 3-mm slices were used in sagittal and axial planes. The signal intensities relative to cerebral white matter varied from 0.51 to 1.23 in the sagittal plane and 0.56 to 1.51 in the axial plane. The signal intensities relative to muscle varied from 0.76 to 2.40 in the sagittal plane and 0.96 to 2.30 in the axial plane. The signal intensities relative to fat varied from 0.22 to 0.62 in the sagittal plane and 0.23 to 0.68 in the axial plane. No correlation with age of the volunteers was found. The normal medulla of the dens may exhibit a low signal intensity on T1-weighted images irrespective of age.

Adipose Tissue↗
PubMed1992

[Fresh fracture of the odontoid process treated with direct screw fixation; a case report].

A case of a fresh type II fracture (Anderson & D'Alonzo) of the odontoid process treated with direct screw fixation is reported. A 52-year-old man complained of severe neck pain following a hit on his forehead incurred in a falling accident. Neurological examination was normal. Cervical spine x-ray films and axial CT scans revealed a fracture at the base of the dens. It was slightly oblique leftup and rightdown, and the dens fragment was displaced 3mm lateral to the right. One week after the injury, this odontoid fracture was directly fixed with a compression screw by an anterior cervical approach. Immediately after the operation, his neck pain disappeared. He had only 4 days of bed rest and 2 months of external immobilization with a simple neck collar. He returned to his previous job 2 months after surgery without any limitation of his neck movement. At follow-up examination 16.5 months after the operation, x-ray films demonstrated complete fusion of the fracture and no problem about the screw such as displacement or breakage. Direct screw fixation of an odontoid fracture via a transcervical approach was thought to be a reasonable method of treatment. For proper assembly of this method, the following two points are particularly recommended: a screw insertion perpendicular to the fracture plane and the use of an optimal screw with both the desired total and thread lengths.

Bone Screws↗
PubMed1988

Odontoid process fracture osteosynthesis with a direct screw fixation technique in nine consecutive cases.

The authors present their experience with surgical treatment of odontoid process fractures using a direct screw fixation technique via an anterolateral retropharyngeal approach. Nine consecutive patients have been operated on with this technique. There were two deaths unrelated to the surgery, and anatomical union with conservation of the craniospinal hinge mobility was achieved in the remaining seven patients. The direct screw fixation technique appears feasible, efficient, and logical.

Adult↗
PubMed1976

[Fractures of the odontoid process of the axis].

Analysis of 15 cases of fracture of the odontoid process of the axis, with a follow-up time of 18 months to 9 years. In 6 cases (40 p. 100) the diagnosis of the fracture was made with a delay extending from one week to 3 months after the accident. The only case complicated with neurological findings was a fracture of the dens without radiological displacement. All patients have been treated conservatively. Twelve fractures united after 4 to 6 months immobilisation. In two cases a tight and stable non-union has developed. In only one case the pseudarthrosis was loose and unstable, and required a surgical fusion. The functional result was dominated by a restriction of movements of the head, variable in its importance, but practically constant.

Adolescent↗
PubMed1988

The odontoid process in children--is it hypoplastic?

An analysis of the cervical spine of 508 normal children aged between 3 and 18.9 years provided data for the normal development of the odontoid process and its relationship to the anterior arch of the atlas. In normal children under the age of 9 years, the tip of the odontoid may fall well short of the upper margin of the anterior arch of the atlas. This has important implications for the assessment of atlanto-axial instability in children with Down's syndrome.

Adolescent↗
PubMed1988

Treatment in fractures of the odontoid process.

Fifty-eight cases of odontoid fractures treated at Keio University Hospital and affiliate hospitals from 1965 through 1985 were reviewed. Six patients under age 7 years (group A), were characterized as having epiphysiolysis. Among 52 patients over 8 years of age (group B), there were two Type I, 31 Type II and 19 Type III fractures. All cases in group A were treated conservatively by a plaster cast or a neck brace, and achieved bony union in 6 to 27 weeks. Five of 24 fractures in group B, treated conservatively, failed to unite. Nineteen cases of Type II and six cases of Type III were treated surgically. Transoral fusion was performed in six cases, internal fixation using a compression screw in ten, bone peg fixation in one, posterior fusion in eight, and posterior decompression in one. Two cases treated with transoral fusion and two with screw fixation failed to unite. We recommend conservative treatment of group A patients, Type I, and acute cases of Type III with minimal displacement in group B. Surgery should be performed in acute cases of Type II, Type III with significant displacement, and nonunion cases in Type II and Type III.

Adolescent↗
PubMed1995

Spontaneous fracture of the odontoid process in a patient with ankylosing spondylitis. Nonunion responsible for compression of the upper cervical cord.

Tetraparesis due to a spontaneous fracture of the base of the odontoid process occurred in a patient with undiagnosed, advanced ankylosing spondylitis. Few cases of insufficiency fractures of the proximal cervical spine in patients with loss of spinal mobility have been reported in the literature. The pathologic lesions that can cause severe neurologic compromise are reviewed. Because functional impairment and neurologic loss are common even after surgical decompression and stabilization, these lesions should be looked for during a careful physical evaluation followed by appropriate investigations.

Fractures, Spontaneous↗
PubMed1983

Indications and technique for the operative treatment of hypoplastic deformities of the odontoid process.

On the basis of four typical cases of congenital hypoplastic deformities of the odontoid process the clinical significance, symptoms, diagnosis and the indications for operative treatment of the malformations are described. It is further shown that these malformations lead to clinical manifestations only when associated with a primarily existing, or a later acquired inadequacy of the ligaments with movement-induced changes in the position of the atlas. The operative treatment recommended involves a special technique for a bilateral dorsal fixation with tibial grafts. By this operative technique a substantial or even completely stable fixation of the atlas can be achieved, in the acute phase by the stability of the tibial grafts and in the long term by the bony fusion which occurs.

Adult↗
PubMedDate not supplied

[Factors of severity in the fractures of the odontoid process (author's transl)].

The authors think that the prognosis in fractures of the odontoid process could be based on an evaluation of the stability and on the direction of the fracture line. The stability depends on the integrity of the common posterior spinal ligament. When it is disrupted, the spine should be surgically fixed. When it is intact, conservative treatment is indicated. The stability should be appreciated on dynamic X rays 15 days after the trauma. The fracture lines oblique anteriorly are more stable than the fracture lines oblique posteriorly. The comminuted type, like "English policeman's hat" are very unstable.

Axis, Cervical Vertebra↗
PubMed1990

Sudden death in rheumatoid arthritis from vertical subluxation of the odontoid process.

Rheumatoid arthritis is a chronic, multisystem disease that causes significant morbidity and early mortality. A common source of morbidity in severe rheumatoid arthritis is involvement of the cervical spine. Sudden death due to subluxation of the odontoid process into the medulla oblongata is a dramatic but rare complication. We report the case of a patient who died suddenly. Computerized tomography scan, autopsy, and clinical findings were correlated. Studies of cervical involvement in rheumatoid arthritis were analyzed for cases of vertical subluxation. The case reports of sudden deaths and patients treated for vertical subluxation were reviewed; they revealed a trend toward surgery in patients with neurological abnormalities. However, a comparison of clinical outcome does not demonstrate improved survival with surgical intervention. Randomized trials comparing surgical with nonsurgical therapy are needed.

Aged↗
PubMed1976

[Fractures of the odontoid process. 94 cases, 61 treated by arthrodesis].

The authors have reviewed 94 cases of fractures of the odontoid process, 21 of the with neurological signs. The conclusions were as follows: 1) Conservative treatment in 26 cases led to 9 non-unions; 2) 27 recent fractures were operated on (arthrodesis) with 24 fusions; 3) 54 cases were treated more than 30 days after the accident: 15 ot them demonstrated neurological involvement, 34 of them were operated on; 4) The surgical technique is fully described, usually the operation aimed at fusing C1 to C2; 5) One patient died, none was aggravated, all were somewhat improved on the neurological standpoint; 6) On a functional standpoint neck mobility was less decreased after conservative treatment than after cervical fusion.

Adult↗