Surgical vs nonoperative treatment of Hadley type IIA odontoid fractures.

Medical University of Vienna, Department of Trauma Surgery, Vienna, Austria.
Neurosurgery (Impact Factor: 3.62). 03/2012; 70(3):676-82; discussion 682-3. DOI: 10.1227/NEU.0b013e318235ade1.
Source: PubMed


Type II odontoid fractures with additional chip fragments are rare in clinical practice, accounting for < 10% of all odontoid fractures. Hadley et al were the first to describe these fractures as an individual subtype (IIA).
To analyze the outcome of patients after surgical or nonoperative treatment of Hadley type IIA odontoid fractures.
We analyzed the records of 46 patients at an average of 64 years of age at the time of injury. Twenty-five patients underwent surgical stabilization by anterior screw fixation and were entered into study group A; 21 patients were treated nonoperatively by halo vest immobilization and included in study group B.
Thirty-seven patients (84%) returned to their preinjury activity level and were satisfied with their treatment. Using the Cervical Spine Outcomes Questionnaire to quantify the clinical outcome, we had an overall outcome score of 21.8. We did not find a significant difference in the overall clinical outcome between study groups. Bony fusion was achieved in 35 patients (80%). We had a nonunion rate of 13% after anterior screw fixation and a significantly higher rate of 30% after halo vest immobilization. Failure of reduction or fixation occurred in 12 patients (27%), with a significantly higher failure rate after halo vest immobilization.
Hadley type IIA odontoid fractures are inherently unstable and impede proper realignment. These fractures have a significantly increased risk for secondary loss of reduction and bony nonunion, particularly after nonoperative management. Early surgery should be considered to avoid further complications.

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    • "For these cases, long term follow up was still essential. The infection rate in surgical site was very low with only seven cases identified during our review [24], [33], [41], [60], [61]. The pooled estimate was 0.2% without significant heterogeneity among the studies. "
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    ABSTRACT: Background Anterior odontoid screw fixation (AOSF) has been one of the most popular treatments for odontoid fractures. However, the true efficacy of AOSF remains unclear. In this study, we aimed to provide the pooled rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid fractures. Methods We searched studies that discussed complications after AOSF for type II or type III odontoid fractures. A proportion meta-analysis was done and potential sources of heterogeneity were explored by meta-regression analysis. Results Of 972 references initially identified, 63 were eligible for inclusion. 54 studies provided data regarding non-union. The pooled non-union rate was 10% (95% CI: 7%–3%). 48 citations provided re-operation information with a pooled proportion of 5% (95% CI: 3%–7%). Infection was described in 20 studies with an overall rate of 0.2% (95% CI: 0%–1.2%). The main approach related complication is postoperative dysphagia with a pooled rate of 10% (95% CI: 4%–17%). Proportions for the other approach related complications such as postoperative hoarseness (1.2%, 95% CI: 0%–3.7%), esophageal/retropharyngeal injury (0%, 95% CI: 0%–1.1%), wound hematomas (0.2%, 95% CI: 0%–1.8%), and spinal cord injury (0%, 95% CI: 0%–0.2%) were very low. Significant heterogeneities were detected when we combined the rates of non-union, re-operation, and dysphagia. Multivariate meta-regression analysis showed that old age was significantly predictive of non-union. Subgroup comparisons showed significant higher non-union rates in age ≥70 than that in age ≤40 and in age 40 to <50. Meta-regression analysis did not reveal any examined variables influencing the re-operation rate. Meta-regression analysis showed age had a significant effect on the dysphagia rate. Conclusions/Significances This study summarized the rates of non-union, reoperation, infection, and approach related complications after AOSF for odontoid factures. Elderly patients were more likely to experience non-union and dysphagia.
    PLoS ONE 07/2014; 9(7):e103065. DOI:10.1371/journal.pone.0103065 · 3.23 Impact Factor
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    ABSTRACT: Study Design. A prospective study.Objective. To evaluate the outcomes of posterior reduction and temporary fixation using the C1-C2 screw-rod system for odontoid fracture unsuitable for anterior screw fixation.Summary of Background Data. Anterior screw fixation has become the most widely used surgical procedure for the stabilization of odontoid fractures. However, if there is any contraindication for anterior fixation, posterior atlantoaxial fusion is preferred, eliminating the normal rotation of the atlantoaxial complex.Methods. A consecutive series of 22 patients with odontoid fracture unsuitable for anterior screw fixation were involved in this study. Posterior reduction and fixation without fusion using the C1-C2 screw-rod system was performed. Once fracture healing was obtained, instrumentation was removed. The visual analog scale (VAS) of neck pain, neck stiffness, American Spinal Injury Association (ASIA) impairment scale, patient satisfaction, and neck disability index (NDI) were recorded. The range of motion (ROM) of C1-C2 in flexion-extension and rotation was calculated.Results. The average age at internal fixation surgery was 40.2±11.3 years. The mean duration of follow up was 41.8±26.8 months. There were no complications associated with instrumentation. All patients returned to their pre-operative work. Fracture healing was observed in 21 patients and the instrumentation was removed. After removing the instrumentation, the VAS was reduced and neck stiffness were relieved (all P < 0.01). Patient satisfaction and NDI were improved (all P < 0.01). The ROM of C1-C2 was returned to 4.75°±1.62°and 25.70°±5.51°in flexion-extension and in rotation, respectively. No osteoarthritis was observed at the C1-C2 lateral mass joints.Conclusions. Posterior reduction and temporary fixation using the C1-C2 screw-rod system was an optimal salvage maneuver to anterior screw fixation for odontoid fracture. It could effectively avoid the motion loss of C1-C2 caused by posterior atlantoaxial fusion.
    Spine 11/2014; 40(3). DOI:10.1097/BRS.0000000000000709 · 2.30 Impact Factor

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