title: Clinical outcomes of halo-vest immobilization and surgical fusion of odontoid fractures.
abstract: OBJECTIVE
  In the present study, authors retrospectively reviewed the clinical outcomes of halo-vest immobilization (HVI) versus surgical fixation in patients with odontoid fracture after either non-surgical treatment (HVI) or with surgical fixation.
  
  
  METHODS
  From April 1997 to December 2008, we treated a total of 60 patients with upper cervical spine injuries. This study included 31 (51.7%) patients (22 men, 9 women; mean age, 39.3 years) with types II and III odontoid process fractures. The average follow-up was 25.1 months. We reviewed digital radiographs and analyzed images according to type of injury and treatment outcomes, following conservative treatment with HVI and surgical management with screw fixation.
  
  
  RESULTS
  There were a total of 31 cases of types II and III odontoid process fractures (21 odontoid type II fractures, 10 type III fractures). Fifteen patients underwent HVI (10 type II fractures, 5 type III fractures). Nine (60%) out of 15 patients who underwent HVI experienced successful healing of odontoid fractures. The mean period for bone healing was 20.2 weeks. Sixteen patients underwent surgery including anterior screw fixation (6 cases), posterior C1-2 screw fixation (8), and transarticular screw fixation (2) for healing the odontoid fractures (11 type II fractures, 5 type III fractures). Fifteen (93.8%) out of 16 patients who underwent surgery achieved healing of cervical fractures. The average bone healing time was 17.6 weeks.
  
  
  CONCLUSIONS
  The overall healing rate was 60% after HVI and 93.8% with surgical management. Patients treated with surgery showed a higher fusion rate and shorter bony healing time than patients who received HVI. However, prospective studies are needed in the future to define better optimal treatment and cost-effective perspective for the treatment of odontoid fractures.
authors: Department of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
authors: Seung Kook
authors: SK
authors: Kim
authors: Jun Jae
authors: JJ
authors: Shin
authors: Tae Hong
authors: TH
authors: Kim
authors: Hyung Shik
authors: HS
authors: Shin
authors: Yong Soon
authors: YS
authors: Hwang
authors: Sang Keun
authors: SK
authors: Park