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Ogden M, Erdogan AM, Karagedik MI, Baser S, Bulut IU, Sevimoglu O, Yuksel U, Bakar B. Analysis of radiological measurement parameters that can predict the type of treatment to be applied in odontoid fractures: Clinical research. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:245-252. [PMID: 37860024 PMCID: PMC10583795 DOI: 10.4103/jcvjs.jcvjs_20_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 07/12/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction Although various conservative and surgical treatment methods have been proposed, treatment options for patients with odontoid fractures remain controversial. This study was conducted to determine some demographic and radiological measurement parameters that can predict treatment options in patients with odontoid fractures. Materials and Methods The patients were separated into the surgery (-) group (n = 9) and the surgery (+) group (n = 10). Patient data were recorded of age, gender, type of odontoid fracture, morphological measurement results obtained from computed tomography images, treatment regimens, duration of stay in the hospital, and mortality rate. In the operating room, a halo-vest corset or Philadelphia-type cervical collar was applied to the surgery (-) patients after the reduction of the fracture under fluoroscopy. Anterior odontoid lag screw fixation was performed on surgery (+) patients. Results The amount of displacement of the fractured odontoid, the distance between the C1 vertebra and the odontoid process, the angle between the posterior wall of the odontoid process and the posterior wall of the clivus, the slip angle, and the anterior to posterior width of the spinal canal were not different between the groups. No difference was determined between the groups in respect of the amount of lateral displacement of the odontoid process in the spinal canal in the axial plane and the angle of the fractured odontoid process with the C2 vertebral body. Conclusion This preliminary study showed that the demographic data and radiological measurement parameters analyzed in the present study could not be used as predictive markers either in decision-making for treatment modality or mortality risk.
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Affiliation(s)
- Mustafa Ogden
- Department of Neurosurgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Ahmet Melih Erdogan
- Department of Neurosurgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | | | - Selcuk Baser
- Department of Radiology, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Ibrahim Umud Bulut
- Department of Neurosurgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Ozge Sevimoglu
- Department of Neurosurgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Ulas Yuksel
- Department of Neurosurgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
| | - Bulent Bakar
- Department of Neurosurgery, Kirikkale University Faculty of Medicine, Kirikkale, Turkey
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Spine trauma: Radiological approach and new concepts. Skeletal Radiol 2021; 50:1065-1079. [PMID: 33165712 DOI: 10.1007/s00256-020-03668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
The spine is the main stabilizer and load bearer of the axial skeleton. It is also important for the protection of neural structures, such as the spinal cord, nerve roots, and cauda equina. In the healthy skeleton, most injuries are a consequence of high-energy trauma and can lead to severe dysfunction, such as tetraplegia or paraplegia. In order to avoid such disabilities, it is important to recognize details that will guide treatment, and that will determine the necessity or not to have surgery. Familiarity with radiography, CT, and MRI in evaluating spine trauma is necessary, as, in some cases, all three methods will be useful in determining management and surgical planning. The most important factor in determining management in the thoracolumbar spine is the posterior ligamentous complex (PLC). Therefore, familiarity with its anatomy, primary and secondary signs of its injuries, is essential for radiologists in the emergency setting. Spine fractures are a very heterogeneous group of disorders. Management can be both conservative and surgical. It is important for radiologists to be aware of classifications and patterns for these injuries.
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AlEissa SI, Alhandi AA, Bugis AA, Alsalamah RK, Alsheddi A, Almubarak AK, AlAssiri SS, Konbaz FM. The incidence of odontoid fractures following trauma in a major trauma center, a retrospective study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:71-74. [PMID: 32904973 PMCID: PMC7462132 DOI: 10.4103/jcvjs.jcvjs_28_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 11/10/2022] Open
Abstract
Background: Cervical spine injury is the most common vertebral injury after major trauma, 20% of all cervical fractures happen to be odontoid fractures. In young adults, odontoid fracture usually happens as a result of high-energy trauma after a motor vehicle accident (MVA). MVA in Riyadh represents 38.4% of all trauma cases, in which the head-and-neck are the most injured body parts. This research aims to provide information about the incidence of odontoid process fracture post-MVA in Riyadh, Saudi Arabia. Methods: The design of this study was retrospective. A single level one trauma center database (trauma registry) was used to identify odontoid fractures post-MVA. All trauma cases from 2008 to the most recent were included, a total of 17,047 patients, to identify cervical spine fractures and further identify odontoid fracture incidence. The patients' radiographs were reviewed retrospectively, and odontoid fractures were classified by a board-certified spine surgeon. A descriptive analysis was carried out to report basic data distribution. Pearson's correlation was carried out to assess associations. Results: A total number of cervical spine fracture was 1195 patients (6.6% of the total sample). The incidence of odontoid fractures during the entire study period from 2008 to 2018 was 42 of 480 patients with C2 cervical trauma, constituting 8.75% C2 fractures, and 3.5% of cervical spine fractures. The mean age was 41.75 ± 18 years. There were three patients (onemale, two females) with type I odontoid fracture, 26 (all males) with type II, and 13 (11 males, 2 females) with type III. Most patients were managed conservatively (83.33%), whereas 16.67% underwent surgical management. Conclusion: The incidence of posttraumatic odontoid fractures is low, given the younger population of this study. This does not predict future incidence rates with the continued improvement of road traffic laws and awareness in the population.
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Affiliation(s)
- Sami Ibrahim AlEissa
- Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, National Guard Health Affaires, Riyadh, Saudi Arabia.,Collage of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ali Abdullah Alhandi
- Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, National Guard Health Affaires, Riyadh, Saudi Arabia
| | | | - Raghad Khalid Alsalamah
- Collage of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulellah Alsheddi
- Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, National Guard Health Affaires, Riyadh, Saudi Arabia
| | - Abdulaziz Khalid Almubarak
- Collage of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Suhail Saad AlAssiri
- Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, National Guard Health Affaires, Riyadh, Saudi Arabia
| | - Faisal MohammedSaleh Konbaz
- Department of Surgery, Division of Orthopedics, King Abdulaziz Medical City, National Guard Health Affaires, Riyadh, Saudi Arabia
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Abstract
Odontoid fractures represent one of the most common and controversial injury types affecting the cervical spine, being associated with a high incidence of nonunion, morbidity, and mortality. These complications are especially common and important in elderly patients, for which ideal treatment options are still under debate. Stable fractures in young patients maybe treated conservatively, with immobilization. Although halo-vest has been widely used for their conservative management, studies have shown high rates of complications in the elderly, and therefore current evidence suggests that the conservative management of these fractures should be carried out with a hard cervical collar or cervicothoracic orthosis. Elderly patients with stable fractures have been reported to have better clinical results with surgical treatment. For these and for all patients with unstable fractures, several surgical techniques have been proposed. Anterior odontoid fixation can be used in reducible fractures with ideal fracture patterns, with older patients requiring fixation with 2 screws. In other cases, C1-C2 posterior fixation maybe needed with the best surgical option depending on the reducibility of the fracture and vertebral artery anatomy. In this paper, current evidence on the management of odontoid fractures is discussed, and an algorithm for treatment is proposed.
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Chacko J, Brar G, Mundlapudi B, Kumar P. Bilateral Lower Cranial Nerve Palsy after Closed Head Injury: A Case Report and Review of Literature. Indian J Crit Care Med 2018; 22:879-882. [PMID: 30662229 PMCID: PMC6311977 DOI: 10.4103/ijccm.ijccm_476_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paralysis of the lower cranial nerves is uncommon after closed head injuries. Most cases reported are unilateral and associated with base of skull fractures, usually involving the occipital condyles. Bilateral lower cranial nerve palsy is even less common, with only a handful of cases reported in literature. A 17-year-old girl presented to us after she was involved in a side-on collision with a car while driving a scooter. She sustained traumatic brain injury requiring mechanical ventilation. Detailed neurological evaluation revealed bilateral paralysis of the IXth, Xth, and XIIth cranial nerves with no evidence of a fracture of the base of skull or brain stem injury. A traction type of injury to the nerves arising from a whiplash mechanism may have led to paralysis of the lower cranial nerves in our patient. An exhaustive review of literature revealed 11 reports of bilateral lower cranial nerve palsy associated with closed head injuries; there were only four cases without underlying fracture of the occipital condyles. Our patient made a complete recovery over a period of 4 months. A traction type of injury to the lower cranial nerves may occur due to a whiplash mechanism. This type of injury may be associated with a favorable outcome.
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Affiliation(s)
- Jose Chacko
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
| | - Gagan Brar
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
| | - Bhargav Mundlapudi
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
| | - Pradeep Kumar
- Department of Critical Care Medicine, Narayana Multispeciality Hospital, Bengaluru, Karnataka, India
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Farrokhi MR, Rezaei H, Farrokhi F. Anterior screw fixation in type II odontoid fracture in an 18-month-old girl: a case report and review of the literature. Br J Neurosurg 2017; 33:699-702. [DOI: 10.1080/02688697.2017.1409881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Majid Reza Farrokhi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Rezaei
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnaz Farrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
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Proposal for subclassification of type I dens axis fractures according to Anderson and D’Alonzo. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-016-0138-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Munakomi S, Tamrakar K, Chaudhary PK, Bhattarai B. Anterior single odontoid screw placement for type II odontoid fractures: our modified surgical technique and initial results in a cohort study of 15 patients. F1000Res 2016; 5:1681. [PMID: 27990259 PMCID: PMC5133680 DOI: 10.12688/f1000research.9131.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2016] [Indexed: 11/24/2022] Open
Abstract
Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous in clinical set ups lacking state of the art facilities. Methods and Results: In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study. Conclusion: Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing patients in developing nations having rudimentary neurosurgical set up.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal
| | - Karuna Tamrakar
- Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal
| | | | - Binod Bhattarai
- Department of Neurosurgery, College of Medical Sciences, Chitwan, Nepal
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Abstract
OBJETIVO: avaliação e determinação de critérios que possam nortear o tratamento das fraturas do odontoide. MÉTODOS: foi realizado estudo retrospectivo e comparativo entre o tratamento conservador e o cirúrgico do odontoide em 24 pacientes com fratura decorrente de trauma. Os pacientes foram avaliados por meio de exame clínico e radiológico e o tratamento efetuado foi avaliado por meio de testes descritivos, distribuição de frequências e testes estatísticos comparativos. RESULTADOS: foram observados 17 pacientes do sexo masculino (70,8%) e 7 do sexo feminino (29,2%), com idades entre 12 e 80 anos (média de 39 anos) e seguimento pós-tratamento de 12 a 110 meses. Em relação às fraturas, não foram observadas fraturas do tipo I, 17 casos apresentaram fratura do tipo II (70,8%) e 7 do tipo III (29,2%), classificadas segundo Anderson e D'Alonzo. A decisão pelo tratamento cirúrgico ou conservador ocorreu em função de critérios de redução e instabilidade. Quando se decidia pelo tratamento cirúrgico, era utilizado o acesso de Southwick-Robinson, utilizando-se um parafuso canulado para a fixação da fratura. Nos pacientes tratados conservadoramente, optou-se pelo halo-gesso ou colar cervical tipo Philadelphia. Independentemente do tipo da fratura, a consolidação ocorreu em média em três meses para os pacientes tratados cirurgicamente, enquanto as fraturas tratadas conservadoramente consolidaram em torno de cinco meses. CONCLUSÕES: apesar de haver uma tendência à consolidação mais rápida quando é realizado o tratamento cirúrgico, o tratamento conservador deve ser considerado, tendo em vista os critérios de redução e instabilidade.
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Affiliation(s)
| | - Leandro de Freitas Spinelli
- Instituto de Ortopedia e Traumatologia de Passo Fundo, Brasil; Universidade Federal do Rio Grande do Sul, Brasil
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