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PubMedDate not supplied

[Fractures of the odontoid process. Incidence and treatment in the Neurosurgical Department of a hospital in Maputo (Mozambique)].

INTRODUCTION: Fractures of the odontoid process make up between 10 and 15% of all cervical fractures. The decision as to when to operate on them is still controversial; the dilemma as to whether to use surgical or conservative treatment is still a problem. PATIENTS AND METHODS: We designed a descriptive study, which was prospective and applied to all patients diagnosed as having a fracture of the odontoid process, admitted to the Neurosurgical Department of Maputo Central Hospital (Mozambique) between June 1997 and May 1998. Follow up was rigorously controlled up to May 2000. All were treated conservatively with a cervical plaster collar. RESULTS: Six cases (83.3%), mainly male, were diagnosed. The patients were aged between 17 and 42 years, with an average age of 26.16 years. The commonest aetiology was a traffic accident (66.6%). Type II fractures were the commonest, seen in 4 patients. All patients complained of pain in the back of their necks. Dysparesia and brachial monoparesia were both seen in 33.3% of the patients. In four cases the fracture consolidated in three months, one in two months and the other after four months. Full recovery was made by 66.6%. CONCLUSIONS: Based on their review of the literature and own practical experience, the authors recommend conservative treatment for fractures of types I and II, immediate surgical operation for type IIA and for type II when the following conditions are met: displacement of over 4 mm, age of over 40 years and diagnosis made over a week after the injury had occurred.

Accidents, Traffic↗

PubMed1989

Cranial subluxation of the odontoid process in rheumatoid arthritis.

In eighteen patients who had long-standing severe rheumatoid polyarthritis, cranial subluxation of the odontoid process was caused by erosion and collapse of both the occipitocervical and the atlantoaxial facet joints. In five of the patients, the subluxation caused impairment of cranial nerves. One patient was tetraparetic. Six patients had a posterior fusion of the spine; of these, three also had laminectomy of the atlas. Operative treatment seemed to arrest the subluxation, but there was appreciable functional improvement in only four of the six patients. During an average of four years of follow-up, in the twelve conservatively treated patients, the cranial subluxation of the odontoid process progressed, on average, from 8.6 to 10.5 millimeters.

Aged↗

PubMed1999

Isolated pyogenic osteomyelitis of the odontoid process.

A case of isolated pyogenic osteomyelitis of the odontoid process is reported. Diagnosis was made using magnetic resonance imaging. Aggressive treatment, including transoral drainage of the abscess, antibiotics and cervical immobilization, resulted in a successful outcome. A review of the world's literature revealed only 15 previous reports of this rare entity.

Adolescent↗

PubMed2000

Diagnosis and treatment of odontoid process fractures in children.

Fractures of the odontoid process in children are rare but account for the majority of all the cervical spine injuries in the infantile and young juvenile groups. The initial radiographic evaluation is often difficult so that the diagnosis-making is delayed or the fractures are missed. The management of the odontoid fractures of adults has long been controversial and varies with different spinal surgeons. By contrast, the diagnosis and treatment of odontoid fractures in skeletally immature children have not been frequently documented and not in details. This paper reviews the clinical characteristics, diagnosis, treatment principles, and long-term outcome of the odontoid fractures in a consecutive series of patients aged 14 years or younger.

Journal Article↗

PubMed1996

[Osteosynthesis of the odontoid process by a clover-shaped plate].

UNLABELLED: The goal was to design an osteosynthesis material able to stabilize after reduction a fracture of the odontoid process without C1-C2 arthrodesis. MATERIAL AND METHODS: The implant comprises a clover shaped plate which has to be applied on one hand on the anterior face of the dens (one leaf), and on the other hand on the anterior face of C3 (2 leaves are applied with a screw one screw for each leaf). A barrel fastened to the 3 leaves (implanted on the anterior face of the leaves, at their junction) gives way to a vertically oriented screw which will carry out dens fixation. The screw makes the compression possible. Placement through a pre-sterno-mastoid-approach, needs a special plate support and 18/10 Kirchner pins preparing the passage of the screw. RESULTS: This screw-plate designed for dens fractures (especially those with anterior displacement incompatible with a simple screwing) led to bone union in all cases. A C2-C3 subluxation operated on with the same technique was reduced and stabilized: a C2-C3 ankylosis was the consequence of a C2-C3 arthrodesis combined with the osteosynthesis. No complication was observed. DISCUSSION AND CONCLUSION: This technique is the only one able to perform dens osteosynthesis without implying postoperative immobilization. It is a significant advantage in elderly or multitrauma patients. A part from dens fractures, it can also help to manage dislocations, subluxations and serious C2-C3 sprains and even combinations as fractures of the odontoid process with axis pedicles fractures.

Bone Plates↗

PubMed1995

Management of type II odontoid process fractures in geriatric patients; a prospective study of sequential cohorts with attention to survivorship.

After institutional review defined an unacceptable mortality rate in nonoperative treatment of elderly patients with odontoid process fracture without neurological deficit, we undertook a prospective study to determine the influence of early surgical stabilization on perioperative mortality in geriatric odontoid process fracture patients without neurologic injury. Analysis suggests that acute perifracture mortality in this high-risk group can be significantly decreased and potentially eliminated by this approach.

Aged↗

PubMed1996

Ganglion cyst of the odontoid process. Case report and review of the literature.

STUDY DESIGN: This case report illustrates that although it is rare, a ganglion cyst can occur intraosseously in the odontoid process. OBJECTIVES: The tissue diagnosis was established by surgical resection of the cyst membrane and evacuation of the cyst content. The patient tolerated the procedure well, and the hospital course was uneventful. SUMMARY OF BACKGROUND DATA: Synovial cyst of the spine is uncommon and is usually found in the lumbar region. Its occurrence in the cervical spine is rare, and no cases in the odontoid process, to the authors' knowledge, have been reported. METHODS: This patient was evaluated initially for neck pain, which led to radiographic studies depicting the lesion. It raised the suspicion of metastatic neoplastic process, although the search for primary source proved to be negative. A biopsy was indicated. RESULTS: Surgical findings consisted of mucoid material field cavity lined by a thin membrane. The cyst was excised, and pathologic evaluation confirmed the diagnosis of synovial cyst. CONCLUSION: The correct radiographic diagnosis of this patient was not made because of lack of experience with such lesions in this location. The authors hope that this case report helps raise the awareness of clinicians in considering this diagnosis when facing similar radiographic presentation.

Aged↗

PubMed2003

Pyogenic osteomyelitis of the odontoid process: single stage decompression and fusion.

STUDY DESIGN: A case report. OBJECTIVES: To document our experience with single stage decompression and fixation in the treatment of pyogenic osteomyelitis of the odontoid process. SUMMARY OF BACKGROUND DATA: Although several investigators have reported a handful of these unusual cases, up until now, there have been no studies concerning a single stage solution in the surgical treatment of this pathology. METHODS: Three patients with osteomyelitis of the odontoid process caused by Staphylococcus aureus underwent surgical treatment in single sessions (transoral decompression combined with posterior fusion as the second step of the operation). Following surgery, the patients underwent a 6-week antibiotic course administered both intravenously and orally. Furthermore, we recommended the use of a hard cervical collar for 8 weeks together with isometric rehabilitation of the cervical muscles. Currently, follow-up results are available for two patients. RESULTS: On examination at 3 months, 6 months, and 1 year after the surgery, both patients had completely recovered with no neurologic deficit. Plain radiographs showed complete posterior fusion after 6 and 12 months, respectively. CONCLUSIONS: We emphasize the advantages of our method in comparison with nonoperative treatment or multisession surgery. The single stage surgical solution led to a shortening of hospitalization time with no need for halo bracing, to excellent results with respect to C-spine stability and to better compliance from the patients.

Abscess↗

PubMed1991

Aneurysmal bone cyst of the odontoid process: case report.

Aneurysmal bone cysts (ABCs) are relatively uncommon, benign lesions. Fully 50% occur in long bones and 20% in the vertebral column, mostly in patients under 20 years of age. We report a case of an ABC in the odontoid process of a 74-year-old who sought treatment for pain and myelopathy. This is the first case reported of an ABC of the odontoid process.

Aged↗

PubMed1998

Odontoid process and C1-C2 corrective osteotomy through a posterior approach: technical case report.

OBJECTIVE AND IMPORTANCE: To demonstrate a new posterior approach to the anterior elements of the atlas and the axis including the odontoid process. CLINICAL PRESENTATION: A 36-year-old woman presented with ankylosing spondylitis and severe flexion deformity of the cervical spine. She had sustained a trauma 5 years previously, causing the inability to look forward or to open the jaw adequately. An examination demonstrated fixed flexion and rotation of the cervical spine, with no neurological deficit. Radiologically, there was fusion of C1, C2, and the clivus. TECHNIQUE: The upper cervical vertebrae were exposed via a midline posterior incision, the posterior arch of C1 was excised, and the vertebral arteries were mobilized. A wedge osteotomy was performed through the lateral masses of C1 and subsequently through the odontoid. The head was repositioned, and C1-C2 lateral mass screws and a Ransford loop were inserted. CONCLUSION: It is possible to gain sufficient surgical access to the odontoid process via a posterior approach. The technique described is of benefit when the alternative anterior approaches to the upper cervical spine are technically difficult or impossible.

Adult↗

PubMed1996

Fractures of the odontoid process in small children: biomechanical analysis and report of three cases.

Odontoid "fractures" in young children typically involve the cartilaginous plate (synchondrosis) that separates the odontoid process from the body of the axis; 58 cases have been described in the literature. We report two cases in which 2-year-old children were involved as backseat passengers in head-on motor vehicle accidents, both were restrained by four-point child's seat harnesses. A biomechanical investigation was carried out using simulation in a real car crash test with a child dummy. This revealed that head-on collisions with a speed absorption of at least 40 km/h are the typical mechanism of injury in children under the age of 3 years involved in motor vehicle accidents. Shearing force is all that is necessary to explain the dens fracture. Both children were immediately symptomatic, and the diagnosis was obvious on radiographs. Neither child had neurological deficit, which correlates well with the literature, where neurological injuries were found only in conjunction with head injuries. After closed reduction, both cases were initially treated conservatively with halo and plaster vest for 12 weeks. In one case, in which the anterior dislocation was less than the diameter of the odontoid shaft, eventless healing occurred. In our second case, despite an anatomic reduction, the odontoid fracture failed to unite. After a temporary posterior fixation of C1/C2 we reamed the synchondrosis from anterior and performed autogenous bone grafting. The posterior fixation wire was removed after 5 months. In contrast to the literature, we do not recommend a permanent posterior fusion of C1/C2. Our two young patients were both followed-up for more than 3 years. Clinical and radiological examination at final follow-up was normal with no signs of atypical growth of the odontoid. In cases of major dislocation with greater instability we recommend primary open reduction and osteosynthesis with appropriate implants. This was done in a third case: a 1 1/2-year-old boy who fell down the stairs and sustained a head injury and an unstable lesion of the odontoid with subtotal paraplegia. The odontoid was fixed with two screws.

Biomechanical Phenomena↗

PubMed2002

Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report.

A 52-year-old man complaining of headache and nuchal pain was treated initially under a diagnosis of bacterial meningitis. The meningitis resisted antibiotic therapy, and one week later was complicated by a ruptured retropharyngeal abscess, which led to the correct diagnosis of osteomyelitis of the odontoid process of the axis. His neck was immobilized in a high neck collar and the retropharyngeal abscess was treated by repeated drainage and irrigation. A long course of antibiotic administration finally resolved the infection. Osteomyelitis of the odontoid process is rare and presents with peculiar signs and symptoms. Careful consideration of the differential diagnosis is needed for the early detection of this potentially serious condition.

Anti-Bacterial Agents↗

PubMedDate not supplied

An evaluation of the results of two non-surgical methods in the treatment of fractures of the odontoid process.

The authors illustrate the results of a series of 47 fractures of the odontoid process all treated according to two non-surgical methods, among the most diffused and accepted: Minerva plaster and halo-plaster. The various elements used to classify odontoid fractures are examined, as is their importance for prognosis. The conclusions refer to two essential points: 1) fractures with a higher risk of nonunion are Anderson type II, with posterior shifting, in elderly patients; 2) reduction and immobilization with a halo-plaster may be considered the first choice of a method for most of these fractures, in consideration of the limited risk of nonunion involved.

Adolescent↗

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↗

PubMedDate not supplied

Fractures of the odontoid process: a report of 15 cases in children younger than 6 years.

Fractures of the odontoid process are rare in children. We retrospectively reviewed 15 cases in children younger than 6 years, with an average follow-up of 4 years and 3 months. Eight of these patients had neurologic involvement; magnetic resonance imaging (MRI) changes were seen in the spinal cord at the cervicothoracic junction in six. This neurologic injury was thought to be due to the major anterior displacement of the upper spine, causing spinal cord stretch at the spinal apex of the cervical and thoracic spine. Eight patients secured in forward-facing car seats were injured as the result of motor vehicle accident. Conservatively treated fractures fused without problem. By contrast, the three cases operated on as the initial management of the fracture had complications postoperatively.

Axis, Cervical Vertebra↗

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↗

PubMed2003

Anomalies of the odontoid process discovered as incidental findings on cephalometric radiographs.

Two patients with unusual developmental anomalies of the odontoid process of the axis are presented. These anomalies were discovered as incidental findings on the cephalometric radiographs obtained as part of orthodontic treatment. Both patients had severe instability of the cervical spine at the articulation between the first and second cervical vertebrae that required referral to a medical specialist. When this was discovered, both patients were asymptomatic, with normal neurologic findings. Surgical stabilization of the spine was considered but deferred because the patients had no neurologic signs or symptoms. To protect them from head injury, the patients were advised to refrain from contact sports and strenuous exercise, and follow-up evaluations were recommended. These cases emphasize the need to evaluate head and neck structures shown on cephalometric radiographs, independent of the traditional morphometric analysis.

Cephalometry↗

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↗