Asdrubal Falavigna1, Orlando Righesso2, Pedro Guarise da Silva2, Carlos Rocca Siri3, Jefferson W Daniel4, José Carlos Esteves Veiga4, Gustavo Borges Laurindo de Azevedo5, Luis Eduardo Carelli5, Ratko Yurac6, Felix Adolfo Sanchez Chavez7, Ericson Sfreddo8, Andre Cecchini8, Marcelo Martins do Reis8, Jose Maria Jiménez Avila9, K Daniel Riew10. 1. Neurosurgery Department, Caxias do Sul University Medical School, Caxias do Sul, Brazil. Electronic address: asdrubalmd@gmail.com. 2. Neurosurgery Department, Caxias do Sul University Medical School, Caxias do Sul, Brazil. 3. National Institute of Orthopedics and Trauma Surgery of Montevideo, Montevideo, Uruguay. 4. Division of Neurosurgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil. 5. National Institute of Traumatology and Orthopedics of Rio de Janeiro, Rio de Janeiro, Brazil. 6. Orthopedic Department, Clinica Alemana and University of Chile, Santiago, Chile. 7. OCA Medical Center in Orthopedics and Trauma Surgery, School of Education, Monterey, Mexico. 8. Neurosurgery Department, Cristo Redentor Hospital, Porto Alegre, Brazil. 9. Tecnológico de Monterrey Campus Guadalajara, Guadalajara, Mexico. 10. Department of Orthopedic Surgery, Columbia University, New York, New York, USA.
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.
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.
Authors: Ivan Lvov; Andrey Grin; Aleksandr Talypov; Ivan Godkov; Anton Kordonskiy; Ulugbek Khushnazarov; Vladimir Smirnov; Vladimir Krylov Journal: Eur Spine J Date: 2020-06-15 Impact factor: 3.134