for: Medscape. Morbidity and mortality related to odontoid fracture surgery in the elderly population. Comparison of percutaneous and open anterior screw fixation in the treatment of type II and rostral type III odontoid fractures. Three types of C2 odontoid fractures: type I is an oblique fracture through the upper part of the odontoid process; type II is a fracture occurring at the base of the odontoid as it attaches to the body of C2; type III occurs when the fracture line extends through the body of the axis. There are two basic choices: a rigid neck brace that holds the spine still until the fracture heals or surgical fixation. A patient may withdraw from the study at any time if they are unwilling to continue on the trial. Please enable it to take advantage of the complete set of features! [Medline]. Index of ADL. Some of these patients had a second surgery to place a longer screw or fuse the spine. Stulík J, Nesnídal P, Kryl J, Vyskočil T, Barna M. [Unstable injuries to the upper cervical spine in children and adolescents]. Share cases and questions with Physicians on Medscape consult. Anderson LD, D'Alonzo RT. 8 (6):e3. For obvious reasons, this study is not blinded. In odontoid fractures, surgical stability can be achieved by either fracture fixation of the C2 body to the odontoid process or by arthrodesis of the C1-C2 motion segment. 2009 May. Oh YG, Lee BJ, Jeon SR, Roh SW, Rhim SC, Park JH. Three types of C2 odontoid fractures: type I is an oblique fracture through the upper part of the odontoid process; type II is a fracture occurring at the base of the odontoid as it attaches to the body of C2; type III occurs when the fracture line extends through the body of the axis. Unstable injuries to the upper cervical spine are a hazard to every elderly person, since associated dysphagia and respiratory restrictions are potential deadly complications [1]. But the transformation of a fibrous union to a bony union takes a long time (months to years) in this age group. Some authors recommend the use of prophylactic antibiotics for up to 72 hours following surgery, and continuation if there is evidence of an infection. Smaller 2.7mm screws could be considered in anatomically smaller odontoids. Patients are eligible for inclusion in this study if they meet all of the following criteria: Acute displaced odontoid fracture, type 2 [13], ▪ Displacement is measured on a multiplanar reconstruction of a cervical spine CT scan and defined as a 5-mm anterior translator displacement, any posterior translator displacement or 10° of angulation [14,15,16,17]. Curr Rev Musculoskelet Med. fracture crossing the base of the odontoid process at the junction with the axis body)1. 18 Suppl 1:2-6. Neurosurgery. 1994;47:1245–51. But in our older years, a fall even while at ground level can fracture one of those upper cervical vertebrae and cause serious problems. 2001;121(1-2):50-5. doi: 10.1007/s004020000182. 2011;25:51–6. We discarded mortality as the primary endpoint due to the fragility of patients above 70 years of age, where hazard causes overlap and sample size issues arise [43]. Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1–C2 fusion. [Medline].
Each method has its own problems and potential complications. PCIF allows direct open reduction of displaced fragments and can reduce any atlantoaxial subluxation. References. [12, 13, 3, 14], Management with the halo vest usually is considered if the initial dens displacement is less than 5 mm, the reduction is performed within 1 week of the injury and is able to be maintained, and the patient is younger than 60 years. Google Scholar.
2005;294:2228–30. Treatment depends on the location of the fracture within the C2 vertebrae defined by the Anderson and D'Alonzo classification system and the patient's risk factors for nonunion (failed bone healing). International Society for the Study of the Lumbar Spine, International Society for the Advancement of Spine Surgery, Royal College of Physicians and Surgeons of Canada. Vaccaro AR, Kepler CK, Kopjar B, Chapman J, Shaffrey C, Arnold P, et al.
-, Guan J, Bisson EF. Surgical options include C2 transpedicular screws and anterior cervical plating. Nucci R.C. (DOC 122 kb), Model informed consent form given to participants or surrogates (the original form uses the Swedish language). 2014;2014:231948. Patients are not included in this study if they meet one or more of the following criteria: ▪ Defined as being admitted to a nursing home or hospital because of dementia, Anatomical anomalies (i.e. The same evaluation will be made at 6 weeks and 3 months. Grauer JN, Shafi B, Hilibrand AS, Harrop JS, Kwon BK, Beiner JM, Albert TJ, Fehlings MG, Vaccaro AR. Koller H, Acosta F, Forstner R, Zenner J, Resch H, Tauber M, et al. F is considered to be an indicator of a dependent patient. The study data will be handled in line with by the European Directive 95/46/EC on data protection. An SAE is considered if it results in the following outcomes: in-hospital death, life-threatening event or neurological worsening. /viewarticle/937320 C2-fractures: part II. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group.
Aydinli U, Kara GK, Ozturk C, Serifoglu R. Surgical treatment of odontoid fractures with C1 hook and C2 pedicle screw construct. 2019 Mar 16; While odontoid screw fixation may be an attractive option to many patients presenting with Type II odontoid fractures, its practical use may be tempered by the aforementioned factors as the procedure does present some technical challenges, even in experienced hands. Our protocol uses SNOSE allocation concealment and simple randomisation. Directly underneath the atlas (C1) is the axis bone, also known as C2. The ability to achieve proper fracture re-alignment, and the ability to achieve screw fixation that satisfactorily stabilizes the fracture adhering to AO principles in lag screw fixation, will influence surgical success. JAMA. 2004;17:158–62. 2008 Apr. If the attending physician suspects a serious adverse event (SAE), the patient’s follow-up will not be discontinued. [Medline]. Article [Full Text]. Treatment of Odontoid Type II Fractures in Octogenarians: Balancing Two Different Treatment Strategies. Cho DC, Sung JK. Trials 19, 452 (2018). Koller H, Kolb K, Zenner J, Reynolds J, Dvorak M, Acosta F, Forstner R, Mayer M, Tauber M, Auffarth A, et al. This protocol been approved and registered with the Uppsala Regional Ethics Committee on 18 May 2011(no.
Assistant Professor, Department of Surgery University of Toronto. 2013;22:953–74. 2009 Aug;38(8):410-6. Dysphagia. Eur Spine J. Stopping guidelines for an effectiveness trial: what should the protocol specify?
Randomisation is concealed using a SNOSE technique. What’s the best way to secure this broken bone in someone who is 70 years old or older? In case of severe adverse advents, the investigator in charge of the study will inform the R&D Council. Ann Intern Med. Boutron I, Altman DG, Moher D, Schulz KF, Ravaud P. CONSORT Statement for randomized trials of nonpharmacologic treatments: a 2017 update and a CONSORT extension for nonpharmacologic trial abstracts. 63 (1):83-9. Or is a posterior approach better? Uncomplicated shallow type III fractures are treated with odontoid screw fixation. The electronic clinical trial database in SweSpine will be kept on file for at least 10 years. To enable health economic analyses (i.e. There has been some controversy regarding operative versus nonoperative management of type II fractures. Issues relating to fracture configuration, the size of the remaining ‘peg' in achieving distal fixation, the need for and ease of fracture reduction and bone density are all variables to consider in the ability to properly place screw(s) with sufficient fixation to encourage fracture healing (Figures 1 and 2). Treatment choice was determined by the physician and/or the patient. Clipboard, Search History, and several other advanced features are temporarily unavailable. Ziai W.C. and Hurlbert R.J., Can J Neurol Sci, 27(4): 294-301, 2000. The analysis will be performed by intention-to-treat (ITT), and sensitivity analyses will include a per-protocol analysis. This means that people in the control group who survive at 1 year might be those who are healthier, which might dilute the actual effect of the intervention on disability. Acta Chir Orthop Traumatol Cech. If the fracture is older than 4 weeks or if the patient possesses a short neck and barrel-shaped chest, consider an alternative treatment approach, such as transarticular screw fixation or Brooks sublaminar fusion. After acute treatment and mobilisation, the patient will be discharged to a suitable level of care in a normal way. The patient may be too fragile medically. A physical therapist and an occupational therapist may exercise your arms, legs, and hands. If the patient/relative chooses not to participate in the USOFT, the patient is treated with a rigid collar, i.e. Figure 1 demonstrates a Computed Tomography scan coronal (Fig. Ying Z, Wen Y, Xinwei W, Yong T, Hongyu L, Zhu H, et al. This website also contains material copyrighted by 3rd parties. Screws pulled out of the body of C2 in patients who had fractures that involved the C2 body.
On 30 October 2017, a search in PubMed was performed with the search term “odontoid[Title] OR dens[Title] AND fracture[title]”. Generally, up to 50% of rotation is lost with these techniques. For these patients who did have surgery, there were some serious complications including nine per cent of the patients who died. Article The halo vest is in place for 12-16 weeks and the fusion rate is over 90%.
The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae (C2, or the axis). Surgical treatment of C2 fractures in the elderly: a multicenter retrospective analysis. For statistical analysis, R version 3.4.1 (R Foundation for Statistical Computing, Vienna, Austria) will be used. Odontoid Fractures (Dens Fractures). Arch Orthop Trauma Surg. 2005;72(2):105-10. The optimal treatment of Type II fractures remains controversial and evidence suggests no standards or guidelines, but rather presents options in care2-4. 2000 Jun 15. 2016 Dec;9(4):505-512. 2016;31:74–83. Their search turned up 42 patients who were treated and followed long enough to record results of treatment.
2019 Aug 15;59(8):321-325. doi: 10.2176/nmc.tn.2018-0249. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Privacy Subversion of allocation concealment in a randomised controlled trial: a historical case study.
AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers.
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