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Johnstone T, Shah V, Schonfeld E, Sadeghzadeh S, Haider G, Marianayagam NJ, Stienen M, Veeravagu A. Type II odontoid fractures in the elderly presenting to the emergency department: an assessment of factors affecting in-hospital mortality and discharge to skilled nursing facilities. Spine J 2024; 24:682-691. [PMID: 38101547 DOI: 10.1016/j.spinee.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND CONTEXT Type II odontoid fractures (OF) are among the most common cervical spine injuries in the geriatric population. However, there is a paucity of literature regarding their epidemiology. Additionally, the optimal management of these injuries remains controversial, and no study has evaluated the short-term outcomes of geriatric patients presenting to emergency departments (ED). PURPOSE This study aims to document the epidemiology of geriatric patients presenting to EDs with type II OFs and determine whether surgical management was associated with early adverse outcomes such as in-hospital mortality and discharge to skilled nursing facilities (SNF). STUDY DESIGN This is a retrospective cohort study. PATIENT SAMPLE Data was used from the 2016-2020 Nationwide Emergency Department Sample. Patient encounters corresponding to type II OFs were identified. Patients younger than 65 at the time of presentation to the ED and those with concomitant spinal pathology were excluded. OUTCOME MEASURES The association between the surgical management of geriatric type II OFs and outcomes such as in-hospital mortality and discharge to SNFs. METHODS Patient, fracture, and surgical management characteristics were recorded. A propensity score matched cohort was constructed to reduce differences in age, comorbidities, and injury severity between patients undergoing operative and nonoperative management. Additionally, to develop a positive control for the analysis of geriatric patients with type II OFs and no other concomitant spinal pathology, a cohort of patients that had been excluded due to the presence of a concomitant spinal cord injury (SCI) was also constructed. Multivariate regressions were then performed on both the matched and unmatched cohorts to ascertain the associations between surgical treatment and in-hospital mortality, inpatient length of stay, encounter charges, and discharge to SNFs. RESULTS A total of 11,325 encounters were included. The mean total charge per encounter was $60,221. 634 (5.6%) patients passed away during their encounters. In total, 1,005 (8.9%) patients were managed surgically. Surgical management of type II OFs was associated with a 316% increase in visit charge (95% CI: 291%-341%, p<.001), increased inpatient length of stay (IRR: 2.87, 95% CI: 2.62-3.12, p<.001), and increased likelihood of discharge to SNFs (OR=2.62, 95% CI: 2.26-3.05, p<.001), but decreased in-hospital mortality (OR=0.32, CI: 0.21-0.45, p<.001). The propensity score matched cohort consisted of 2,010 patients, matching each of the 1,005 that underwent surgery to 1,005 that did not. These cohorts were well balanced across age (78.24 vs 77.91 years), Elixhauser Comorbidity Index (3.68 vs 3.71), and Injury Severity Score (30.15 vs 28.93). This matching did not meaningfully alter the associations determined between surgical management and in-hospital mortality (OR=0.34, CI=0.21-0.55, p<.001) or SNF discharge (OR=2.59, CI=2.13-3.16, p<.001). Lastly, the positive control cohort of patients with concurrent SCI had higher rates of SNF discharge (50.0% vs 42.6%, p<.001), surgical management (32.3% vs 9.7%, p<.001), and in-hospital mortality (28.9% vs 5.6%, p<.001). CONCLUSIONS This study lends insight into the epidemiology of geriatric type II OFs and quantifies risk factors influencing adverse outcomes. Patient informed consent should include a discussion of the protective association between definitive surgical management and in-hospital mortality against potential operative morbidity, increased lengths of hospital stay, and increased likelihood of discharge to SNFs. This information may impact patient treatment selection and decision making.
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Affiliation(s)
- Thomas Johnstone
- Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA; Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA.
| | - Vaibhavi Shah
- Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA; Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Ethan Schonfeld
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Sina Sadeghzadeh
- Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, CA 94304, USA; Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Ghani Haider
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Neelan J Marianayagam
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
| | - Martin Stienen
- Department of Neurosurgery & Spine Center of Eastern Switzerland, Kantonsspital St.Gallen, St.Gallen, Switzerland
| | - Anand Veeravagu
- Department of Neurosurgery, School of Medicine, Stanford University. 453 Quarry Rd, Stanford, CA 94305 USA
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Foote CW, Salottolo K, Doan XL, Vanier C, Betancourt AJ, Bar-Or D, Palacio CH. Operative Management Improves Near-term Survival of Patients With Odontoid Type II Fractures: A Propensity-matched National Registry Analysis. Clin Spine Surg 2024; 37:15-22. [PMID: 37651564 PMCID: PMC10810352 DOI: 10.1097/bsd.0000000000001511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/19/2023] [Indexed: 09/02/2023]
Abstract
STUDY DESIGN National Trauma Data Bank (NTDB) review and propensity-matched analysis. OBJECTIVE To evaluate differences in clinical outcomes by operative management. SUMMARY OF BACKGROUND DATA Odontoid type II fractures are the most prevalent cervical fracture. Operative intervention on these fractures is frequently debated; surgical risks are compounded by clinical severity, patient age, and comorbidities. METHODS This registry review included index admissions for odontoid type II fractures [International Classification of Diseases (ICD)-10 codes beginning with S12.11] from 1/1/2017 to 1/1/2020; patients who died in the emergency department (ED) were excluded. Propensity score techniques were used to match patients 1:1 by surgical management, using a caliper distance of 0.05, after matching on the following covariates that differed significantly between surgical and nonsurgical patients: age, sex, race, cause of injury, transfer status, injury severity score, ED Glasgow coma score, ED systolic blood pressure, presence of transverse ligamentous injury, cervical dislocation, and 8 comorbidities. The following outcomes were analyzed with McNemar tests and Wilcoxon signed-rank tests: near-term survival (discharged from the hospital to locations other than morgue or hospice), intensive care unit (ICU) admission, hospital complications, median hospital length of stay (LOS), and median ICU LOS. RESULTS There were 16,607 patients, 2916 (17.6%) were operatively managed and 13,691 were nonoperatively managed. Before matching, survival was greater for patients managed operatively compared with nonoperatively (95.0% vs. 88.2%). The matched population consisted of 5334 patients: 2667 patients in the operative group (91.5% of this population) and 2667 well-matched patients in the nonoperative group. After matching, there was a survival benefit for patients who were operatively managed compared with nonoperative management (94.8% vs. 91.4% P <0.001). However, operative management was associated with greater development of complications, ICU admission, and longer hospital and ICU LOS. CONCLUSION Compared with nonoperative management, operative management demonstrated a significant near-term survival benefit for patients with odontoid type II fractures in select patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Christopher W. Foote
- South Texas Health System Trauma Department, McAllen Medical Center, McAllen, TX
- Valley Health System General Surgery Residency Program, Las Vegas, NV
| | | | - Xuan-Lan Doan
- South Texas Health System Trauma Department, McAllen Medical Center, McAllen, TX
- Valley Health System General Surgery Residency Program, Las Vegas, NV
| | - Cheryl Vanier
- Touro University Nevada College of Osteopathic Medicine, Henderson, NV
| | | | - David Bar-Or
- Trauma Research Department, McAllen Medical Center, McAllen, TX
| | - Carlos H. Palacio
- South Texas Health System Trauma Department, McAllen Medical Center, McAllen, TX
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Nagashima Y, Nishimura Y, Matsuo M, Tanei T, Saito R. Direct Screw Osteosynthesis for an Elderly Osteoporotic Patient With C2 Complex Fracture. Cureus 2023; 15:e42510. [PMID: 37637650 PMCID: PMC10457175 DOI: 10.7759/cureus.42510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2023] [Indexed: 08/29/2023] Open
Abstract
There are various types of C2 fractures, including odontoid fractures, hangman fractures, and complex fractures, which involve the vertebral body or multiple fracture types. The published literature on C2 complex fractures is limited, and treatment strategies have not yet been established. An 80-year-old woman with a history of osteoporosis, brain stroke, and cervical spondylosis fell and sustained a C2 complex fracture. Initial treatment with a cervical collar was unsuccessful and a C2 direct screw osteosynthesis surgery was performed under an image-guided three-dimensional navigation system. The surgical procedure was successfully performed with a surgical time of 83 minutes and a blood loss of 31 ml. Her neck pain improved after surgery. Follow-up CT scans revealed acceptable healing of the fracture four months later. C2 direct screw osteosynthesis is a viable treatment option for C2 complex fractures, particularly in elderly patients who may benefit from early stabilization of the fracture to prevent complications associated with long-term conservative treatment.
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Affiliation(s)
| | - Yusuke Nishimura
- Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Mamoru Matsuo
- Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Takafumi Tanei
- Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, JPN
| | - Ryuta Saito
- Neurosurgery, Nagoya University Graduate School of Medicine, Nagoya, JPN
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Ismail R, Manganaro M, Schartz D, Worley L, Kessler A. A pictorial review of imaging findings associated with upper cervical trauma. Emerg Radiol 2023:10.1007/s10140-023-02141-w. [PMID: 37254028 DOI: 10.1007/s10140-023-02141-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Abstract
The diagnosis of cervical spine injury in the emergency department remains a critical skill of emergency room physicians as well as radiologists. Such diagnoses are often associated with high morbidity and mortality unless readily identified and treated appropriately. Both computed tomography (CT) and magnetic resonance imaging (MRI) often are crucial in the workup of spinal injury and play a key role in arriving at a diagnosis. Unfortunately, missed cervical spine injuries are not necessarily uncommon and often precede detrimental neurologic sequalae. With the increase in whole-body imaging ordered from the emergency department, it is critical for radiologists to be acutely aware of key imaging features associated with upper cervical trauma, possible mimics, and radiographic clues suggesting potential high-risk patient populations. This pictorial review will cover key imaging features from several different imaging modalities associated with upper cervical spine trauma, explore patient epidemiology, mechanism, and presentation, as well as identify confounding radiographic signs to aid in confident and accurate diagnoses.
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Affiliation(s)
- Rahim Ismail
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Mark Manganaro
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Derrek Schartz
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
| | - Logan Worley
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA.
| | - Alexander Kessler
- Department of Imaging Science, University of Rochester, 601 Elmwood Ave, Rochester, NY, 14642, USA
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Berkay F, Minhas A, Lyons JG, Fonte E, Foster N. Epidemiology of C2 fractures in the United States: A National Electronic Injury Surveillance System database study. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:187-193. [PMID: 37448502 PMCID: PMC10336903 DOI: 10.4103/jcvjs.jcvjs_37_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: 04/05/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction C2 fractures are one of the most common traumatic injuries of the cervical spine, with high rates of morbidity and mortality. Current literature on the incidence of C2 fractures is limited to populations outside of the United States (US), prior to 2014, or specific age cohorts. The purpose of this study is to report the incidence rate (IR) of C2 fractures and associated patient demographics in the US between 2002 and 2021 using the National Electronic Injury Surveillance System (NEISS) database. Methods This study analyzed the NEISS database to identify cases of C2 fractures presenting to US Emergency Departments (EDs) from 2002 to 2021. Annual and overall numbers of fractures, IR, and patient demographics were analyzed. IR is expressed as the number of fractures per 100,000 person-years at risk (PYR). Patients were split into three different age groups for comparison (children and young adults, 0-64 years; older adults, 65-79 years; elderly individuals, 80 + years). Results A national estimate of n = 72,764 patients (95% confidence interval [CI] = 54,371-91,156) presented to US EDs with a C2 fracture (IR was 1.17/PYR; 95% CI = 0.87-1.46), and elderly individuals had the highest IR overall (IR = 15.9; P < 0.05). The IR of C2 fractures between 2002 and 2021, reported as average annual percent change (AAPC), increased significantly, regardless of age or sex (AAPC = 10.9; 95% CI = 6.3-15.6; P < 0.0001). Conclusion C2 fractures occur at higher rates than previous years, with especially high IR in elderly individuals. Emphasis of public health efforts toward osteoporosis and coordination difficulties in elderly individuals would likely significantly reduce the overall IR of these injuries.
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Affiliation(s)
- Fehmi Berkay
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Arjun Minhas
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Joseph G. Lyons
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Elizabeth Fonte
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
| | - Norah Foster
- Department of Orthopaedic Surgery, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
- Department of Orthopaedic Surgery, Miami Valley Hospital, Dayton, OH, USA
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Wick J, Le H, Wick K, Peddada K, Bacon A, Han G, Carroll T, Swinford S, Javidan Y, Roberto R, Martin A, Ebinu J, Kim K, Klineberg E. Patient Characteristics, Injury Types, and Costs Associated with Secondary Over-Triage of Isolated Cervical Spine Fractures. Spine (Phila Pa 1976) 2022; 47:414-422. [PMID: 34366413 DOI: 10.1097/brs.0000000000004190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To aim of this study was to identify patient variables, injury characteristics, and costs associated with operative and non-operative treatment following inter-facility transfer of patients with isolated cervical spine fractures. SUMMARY OF BACKGROUND DATA Patients with isolated cervical spine fractures are subject to inter-facility transfer for surgical assessment, yet are often treated nonoperatively. The American College of Surgeons' benchmark rate of "secondary over-triage" is <50%. Identifying patient and injury characteristics as well as costs associated with treatment following transfer of patients with isolated cervical spine fractures may help reduce rates of secondary over-triage and healthcare expenditures. METHODS Patients transferred to a Level-1 trauma center with isolated cervical spine fractures between January 2015 and September 2020 were identified. Patient demographics, comorbidities, insurance data, injury characteristics, imaging workup, treatment, and financial data were collected for all patients. Multivariable logistic regression models were constructed to identify patient and injury characteristics associated with surgical treatment. RESULTS Nearly 75% of patients were treated non-operatively. Over 97% of transfers were accepted by the general surgery trauma service. Multivariable modeling found that higher BMI, presence of any neurologic deficit including spinal cord or isolated spinal nerve root injuries, present smoking status, or cervical spine magnetic resonance imaging obtained post-transfer, were associated with surgical treatment for isolated cervical spine fractures. Among patients with type II dens fractures, increased fracture displacement was associated with surgical treatment. Median charges to patients treated operatively and nonoperatively were $380,890 and $90,734, respectively. Median hospital expenditures for patients treated operatively and nonoperatively were $55,115 and $12,131, respectively. CONCLUSION A large proportion of patients with isolated cervical spine fractures are subject to over-triage. Injury characteristics are important for determining need for surgical treatment, and therefore interfacility transfer. Improving communication with spine surgeons when deciding to transfer patients may significantly reduce health care costs and resource use.Level of Evidence: 4.
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Affiliation(s)
- Joseph Wick
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Hai Le
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Katherine Wick
- Department of Internal Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Kranti Peddada
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Adam Bacon
- University of California Davis School of Medicine, Sacramento, CA
| | - Gloria Han
- University of California Davis School of Medicine, Sacramento, CA
| | - Trevor Carroll
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Steven Swinford
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Yashar Javidan
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Rolando Roberto
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Allan Martin
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Julius Ebinu
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Kee Kim
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, CA
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA
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Traumatic cervical spine fracture patterns on CT: a retrospective analysis at a level 1 trauma center. Emerg Radiol 2021; 28:965-976. [PMID: 34117506 DOI: 10.1007/s10140-021-01952-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of our study was to determine common acute traumatic cervical spine fracture patterns on CT cervical spine (CTCS). METHODS We retrospectively reviewed 1091 CTCS positive for traumatic fractures performed over a 10-year period at a level 1 trauma center. Fractures were classified by vertebral level, laterality, and anatomic location (anterior/posterior arch, body, odontoid, pedicle, facet, lateral mass, lamina, spinous process, transverse foramina, and transverse processes). RESULTS C2 was the most commonly fractured vertebra (38% of all studies), followed by C7 (32.4%). 48.7% of studies had upper cervical spine (C1 and/or C2) fractures. 39.7% of positive studies involved > 1 vertebral level. Conditioned on fractures at one cervical level, the probability of fracture was greatest at adjacent levels with a 50% chance of sustaining a C7 fracture with C6 fracture. However, 31.3% (136) of studies with multi-level fractures had non-contiguous fractures. The most common isolated vertebral process fracture was of the transverse process, seen in 89 (8.2%) studies at a single level, 27 (2.5%) studies at multiple levels. Subaxial spine vertebral process fractures outnumbered body fractures with progressive dominance of vertebral process fracture down the spine. CONCLUSION C2 was the most commonly fractured vertebral level. Multi-level traumatic cervical spine fractures constituted 40% of our cohort, most commonly at C6/C7 and C1/C2. Although the conditional probability of concurrent fracture in studies with multi-level fractures was greatest in contiguous levels, nearly one-third of multi-level fractures involved non-contiguous fractures.
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Bakhsh A, Alzahrani A, Aljuzair AH, Ahmed U, Eldawoody H. Fractures of C2 (Axis) Vertebra: Clinical Presentation and Management. Int J Spine Surg 2020; 14:908-915. [PMID: 33560250 PMCID: PMC7872410 DOI: 10.14444/7139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Injuries of the upper cervical spine are a major cause of morbidity and mortality due to associated spinal cord and head injuries. The injury patterns of the upper cervical spine are numerous, and the neurologic sequelae are diverse. The axis (C2) is the most commonly fractured vertebra in the upper cervical spine; its unique anatomy and architecture pose difficulties in the diagnosis and the management of its fractures. METHODS All cases of acute spinal injuries at Prince Mohammed Bin Abdulaziz Hospital in Riyadh, Saudi Arabia, were screened for fractures of C2 vertebrae. These patients underwent computerized tomography (CT) imaging of the cervical spine with special attention paid to the cranio-cervical junction. Magnetic resonance imaging (MRI) and angiography of the neck were performed to exclude ligamentous tears and vascular injuries. Unstable fractures were fixed surgically. In the remaining cases, a conservative trial was given. All patients were followed up once every 3 months for a period of 1 year. During follow-up, some patients underwent additional CT imaging of the cervical spine to monitor the healing of fractures. RESULTS Out of 230 spinal trauma patients, 43.5% suffered from cervical spine injury. C2 fractures were recorded in 26% cases, and fractures of the C2 vertebral body, including pedicles, laminae, lateral masses, and articular processes, were found in many cases, followed by odontoid fractures (50%). No case of atlanto-axial or atlanto-occipital dislocation was recorded. Road traffic accidents were found to be responsible for 92% of cases. The majority of patients were young males, and 96% of patients had no neurological deficit. Only 15% of the patients required surgery for their unstable fractures. Half of the patients attended outpatient follow -up appointments, all of whom underwent CT scanning of the cervical spine 9 months after the accident or operation. CONCLUSIONS The axis (C2) is the most commonly affected vertebra in cervical spine trauma, and odontoid fractures make up 50% of all C2 fractures. C2 fractures rarely cause any neurological deficit or vascular injury, and the majority of affected patients can be managed conservatively; only a small proportion requires surgical intervention. Surgical intervention leads to early and complete healing.
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Affiliation(s)
- Ahmed Bakhsh
- Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | - Hany Eldawoody
- Department of Neurosurgery, Mansoura Faculty of Medicine, Mansoura University, Egypt, and Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Kingdom of Saudi Arabia
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Rizvi SAM, Helseth E, Rønning P, Mirzamohammadi J, Harr ME, Brommeland T, Aarhus M, Høstmælingen CT, Ølstørn H, Rydning PNF, Mejlænder-Evjensvold M, Utheim NC, Linnerud H. Odontoid fractures: impact of age and comorbidities on surgical decision making. BMC Surg 2020; 20:236. [PMID: 33054819 PMCID: PMC7556921 DOI: 10.1186/s12893-020-00893-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022] Open
Abstract
Background Surgical fixation is recommended for type II and III odontoid fractures (OFx) with major translation of the odontoid fragment, regardless of the patient’s age, and for all type II OFx in patients aged ≥50 years. The level of compliance with this recommendation is unknown, and our hypothesis is that open surgical fixation is less frequently performed than recommended. We suspect that this discrepancy might be due to the older age and comorbidities among patients with OFx. Methods We present a prospective observational cohort study of all patients in the southeastern Norwegian population (3.0 million) diagnosed with a traumatic OFx in the period from 2015 to 2018. Results Three hundred thirty-six patients with an OFx were diagnosed, resulting in an overall incidence of 2.8/100000 persons/year. The median age of the patients was 80 years, and 45% were females. According to the Anderson and D’Alonzo classification, the OFx were type II in 199 patients (59%) and type III in 137 patients (41%). The primary fracture treatment was rigid collar alone in 79% of patients and open surgical fixation in 21%. In the multivariate analysis, the following parameters were significantly associated with surgery as the primary treatment: independent living, less serious comorbidities prior to the injury, type II OFx and major sagittal translation of the odontoid fragment. Conversion from external immobilization alone to subsequent open surgical fixation was performed in 10% of patients. Significant differences the in conversion rate were not observed between patients with type II and III fractures. The level of compliance with the treatment recommendations for OFx was low. The main deviation was the underuse of primary surgical fixation for type II OFx. The most common reasons listed for choosing primary external immobilization instead of primary surgical fixation were an older age and comorbidities. Conclusion Major comorbidities and an older age appear to be significant factors contributing to physicians’ decision to refrain from the surgical fixation of OFx. Hence, comorbidities and age should be considered for inclusion in the decision tree for the choice of treatment for OFx in future guidelines.
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Affiliation(s)
- Syed Ali Mujtaba Rizvi
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Pål Rønning
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Jalal Mirzamohammadi
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Marianne Efskind Harr
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | | | - Håvard Ølstørn
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | | | | | - Nils Christian Utheim
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway
| | - Hege Linnerud
- Department of Neurosurgery, Oslo University Hospital, Mailbox 4956, 0424, Oslo, Norway.
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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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