Management of type II odontoid fractures: experience from latin american spine centers
Date
2017
Type:
Artículo
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9
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ORCID:
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Volume Title
Publisher
Elsevier
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Abstract
OBJECTIVE:
To analyze characteristics of type II odontoid fracture (TII-OF), including clinical and radiographic
factors, that influence surgical planning in 8 Latin American centers.
METHODS:
Retrospective chart review was performed of 88 patients with TII-OF between 2004 and 2015 from
8 Latin American centers. Parameters studied included 1) demographic data and causes of TII-OF, 2)
clinical and neurologic presentation, 3) characteristics of fracture (degree of odontoid displacement,
displacement of odontoid relative to C2 body, anatomy of fracture line, distance between
fragments, presence of comminution, contact area between odontoid and C2 body), 4) type of
treatment, and 5) clinical and radiographic outcome. Bone fusion was assessed using computed
tomography.
RESULTS:
Mean patient age was 45.33 years ± 23.54; 78.4% of patients were male. 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, local pain, and a smaller bone contact
surface between the odontoid and the body of C2. A posterior approach was chosen when distance
between the fractured bone fragments was >2 mm or after failed conservative or anterior odontoid
screw treatment in a symptomatic patient.
CONCLUSION:
The treatment of choice for TII-OF in 8 Latin American trauma centers was surgery through an
anterior approach using screw fixation. Posterior segmental C1-C2 fixation was indicated when
distance between bone fragments was >2 mm and in symptomatic patients with nonunion.
Description
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Citation
World Neurosurg. 2017 Feb;98:673-681
Keywords
Conservative treatment, Geriatrics, Latin America, Surgical procedures, Type II odontoid fracture