Determining the stability of a Type III Odontoid fracture requires radiographic evaluation.
2 Type 3 odontoid fractures are classified by a fracture of the Odontoid process, as well as the lateral masses of the C2. This fracture is unstable and requires operative stabilization. It is considered a stable fracture. Type 2 is the most common and is a fracture involving the base of the odontoid process, below the transverse component of the cruciform ligament. Type 1 is the rarest and is a fracture involving the superior segment of the Dens. Odontoid fractures comprise approximately 10% of vertebral fractures, and there are three types with varying stability. Hyperextension or hyperflexion injuries can induce significant stress causing fractures. Unique to C2 is a bony prominence, the Odontoid Process (Dens). The cervical spine is composed of seven vertebrae, with C1 and C2 commonly referred to as the Atlas and Axis, respectively. He was evaluated by orthopedic spine service who recommended conservative, non-operative management. Significant findings:Ĭomputed Tomography (CT) of the cervical spine showed a stable, acute, non-displaced fracture of the odontoid process extending into the body of C2, consistent with a Type III Odontoid Fracture. He was neurovascularly intact, and placed in an Aspen Collar with strict spine precautions. Exam was notable for left parietal scalp laceration and midline cervical spine tenderness with no obvious deformities. Both fixation techniques promote bony fusion and provide substantial construct stability.An 84-year-old male presented with left-sided posterior head, neck, and back pain after a ground level fall. Displaced reducible, nonunited type II odontoid fracture with cervical myelopathy should be treated by surgery. No severe complications were observed in either group. The mean time to fusion was 69.7 (95%CI 53.1, 86.3) days in Magerl's C1-C2 transarticular screw fixation technique and 75.2 (95%CI 51.8, 98.6) days in Harms-Goel C1-C2 screw-rod fixation technique. The bony fusion rate was 100% in both groups. Of 21 patients, 10 patients were treated with Magerl's C1-C2 transarticular screw fixation technique augmented with supplemental wiring, and 11 were treated with Harms-Goel C1-C2 screw-rod fixation technique. We reported the fusion rate, fusion period, and complications for each technique.
For each patient, specific surgical fixation, either Magerl's C1-C2 transarticular screw fixation technique augmented with supplemental wiring or Harms-Goel C1-C2 screw-rod fixation technique, was performed according to our management protocol. Medical records of patients with reducible nonunited type II odontoid fracture hospitalized for spinal fusion between April 2007 and April 2018 were reviewed. This study aimed to demonstrate the results of two surgical fixation techniques for the treatment of reducible nonunited type II odontoid fracture with atlantoaxial instability.
Both Magerl's C1-C2 transarticular screw fixation technique and Harms-Goel C1-C2 screw-rod segmental fixation technique are effective techniques to provide stability. Displaced nonunited type II odontoid fracture can result in atlantoaxial instability, causing delayed cervical myelopathy.