Surgical management of odontoid fractures at level one trauma center: a single-center series of 142 cases.
BACKGROUND
Odontoid fractures constitute 9-20% of all adult cervical spine fractures. The present study was carried out to focus on the nuances involved in the surgical management of odontoid fractures.


METHODS
Patients with an odontoid fracture, admitted for surgical stabilization, between January 2008 and March 2014, were included in the study.


RESULTS
Among 142 patients [127 male and 15 female patients; median age: 28 years range 4-75 years], type II odontoid fractures were present in 111, type IIA fractures in 8, and type III fractures in 23 patients. 58.5% patients had been involved in a motor vehicular accident while 38.7% had sustained a fall. Eighty-five patients (59.9%) with a well-reduced fracture and an intact transverse ligament underwent anterior odontoid screw (OS) placement; the other 57 patients (40.1%) underwent posterior fixation (PF). The mean follow-up duration was 22 months (range: 6 months-5.4 years). OS placement was successful in 82 patients (96.5%) with a fusion rate of 95% (95.8% in type II, 100% in type III, and 75% in type IIA odontoid fractures). The procedure-related morbidity was 11.7%. One patient died of sub-arachnoid hemorrhage (SAH) that occurred during OS placement. The PF procedures had a better fusion rate (96.5%). The latter patients, however, had significant restriction of their neck movements and an overall morbidity of 8.7%. The revision surgery rates after OS placement and PF fixation were 7% and 3.5%, respectively.


CONCLUSIONS
Anterior OS fixation shows excellent fusion rates and should be the first-line management in reduced/non-displaced acute type II (including type IIA) and high type III odontoid fractures as it preserves cervical motion. PF, that has also been associated with an excellent fusion rate, should be reserved for patients where OS fixation has either failed or has not been feasible.
Dattaraj Paramanand
DP
Sawarkar
Department of Neurosurgery and Gamma Knife Center, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
Pankaj Kumar
PK
Singh
Saquib Azad
SA
Siddique
Deepak
D
Agrawal
Guru Dutta
GD
Satyarthee
Deepak Kumar
DK
Gupta
Sumit
S
Sinha
Shashank S
SS
Kale
Bhawani Shanker
BS
Sharma
D000293:Adolescent; D000328:Adult; D000368:Aged; D001863:Bone Screws; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D014193:Trauma Centers