Management of Type II Odontoid Fractures: Latin American Spine Centers Experience

• Published in: World neurosurgery
• Main Authors: Falavigna, Asdrubal, MD, PhD, Righesso, Orlando, MD, PhD, da Silva, Pedro Guarise, Siri, Carlos Rocca, Daniel, Jefferson W, Esteves Veiga, José Carlos, MD, PhD, Laurindo de Azevedo, Gustavo Borges, Yurac, Ratko, Sanchez Chavez, Felix Adolfo, Sfreddo, Ericson, Cecchini, Andre, do Reis, Marcelo Martins, Riew, K. Daniel
• Format: Journal Article
• Language: English
• Published: 2016
• Subjects: Neurosurgery; Type-II odontoid fractures; CT; conservative treatment; Computed tomography; X-ray; Surgical procedures; Type II odontoid fracture; TII-OF; Plain radiographic; Geriatrics; Latin America
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.10.120

Abstract Objective To analyze the characteristics of type-II odontoid fractures (TII-OF); the clinical and radiographical factors that influence surgical planning in eight Latin American centers. Methods Retrospective chart review of 88 patients reported with TII-OF between 2004 and 2015 from eight Latin American centers. The studied parameters were: (I) demographic data, (II) cause of fracture, (III) clinical and neurologic presentation, (IV) characteristics of the fracture (degree of odontoid displacement, displacement of the odontoid relative to the C2 body, anatomy of the fracture line, the distance between fragments, presence of comminution, contact area between the odontoid and the C2 body, (V) type of treatment, (VI) clinical and radiographic outcome. Bone fusion was assessed using computed tomography. Results Mean age was 45.33 (±23.54) years; 78.4% were males. Surgery was the primary treatment in 65 patients (73.8%), with an anterior approach in 64.6%. Surgery was usually preferred in patients with posterior or horizontal oblique fracture lines, when there was local pain, and a smaller bone contact surface between the odontoid and the body of C2. A posterior approach was elected when a greater than 2mm distance between the fractured bone fragments occurred or after a symptomatic patient secondary to a failed conservative or anterior odontoid screw treatment. Conclusion The treatment of choice for TII-OF in the eight Latin American trauma centers was surgery through an anterior approach using a screw fixation. Posterior segmentar C1-C2 fixation was indicated when the distance between bone fragments was greater than 2 mm and in symptomatic non-union patients.