ODONTOİD FRAKTÜR YÖNETİMİ: KLİNİK DENEYİM

Year 2021, , 649 - 653, 30.12.2021

Ali Serdar Oğuzoğlu , Nilgün Şenol , Mustafa Sadef , Alpkaan Duran Murat Goksel

https://doi.org/10.17343/sdutfd.974524

Abstract

Amaç
Kliniğimize başvuran odontoid kırıklı hastalara uyguladığımız
tedavi yaklaşımlarını literatür eşliğinde sunmayı
amaçladık.
Gereç ve Yöntem
Kliniğimize başvuran odontoid kırıklı 18 hasta retrospektif
olarak değerlendirildi. Hastaların 6’sı kadın,
12’si erkek ve yaş ortalamaları 45,5 (16-87) idi. 7 hastada
Tip 1, 4 hastada Tip 2, 7 hastada Tip 3 kırık tespit
edildi. Tip 1 kırık tespit edilen hastaların %86’sı (n=6),
tip 3 kırık tespit edilen hastaların %57’si (n=4) konservatif
takip edilirken, tip 2 kırıkların tümüne anterior
odontoid vidalama, tip 3 kırıklı 1 hastaya posterior
artrodez uygulandı. Konservatif tedavi edilen hastaların
6’sında Halo-Vest, 3’ünde Philadelphia boyunluk,
2’sinde sterno-oksipito-mandibüler immobilizasyon
(SOMİ) kullanıldı.
Bulgular
Konservatif takip edilen 11 hastadan 7’sinde (%64)
füzyon izlenirken, 4’ünde (%36) füzyon gelişmemesi
üzerine cerrahi planlandı. Hastalardan 2’si şikayetlerinin
olmaması nedeni ile cerrahiyi kabul etmedi.
Anterior cerrahi yapılan 1 hastada vida malpozisyonu
görülerek posterior oksipitoservikal füzyon yapıldı.
Sonuç
Odontoid kırıklarında tedaviye karar verirken fraktür
tipi ve hasta yaşı dikkate alınmalıdır. Cerrahi teknik
belirlenirken klinik iyileşmenin yanısıra füzyon oranı
da önemlidir. Anterior vidalama hareketin daha iyi korunabilmesi
için genç hastalarda; mekanik yetmezlikle
karşılaşmamak ve diğer komplikasyonları en aza
indirebilmek amacıyla posterior füzyon ileri yaşlı hastalarda
tercih edilmelidir. Ancak halen uygun tedavi
stratejisi net değildir.

Keywords

odontoid, odontoid vidalama, konservatif yaklaşım, C1-C2 artrodez

Supporting Institution

Yok

Project Number

Yok

Thanks

-

ODONTOID FRACTURE MANAGEMENT: CLINICAL EXPERIENCE

Abstract

Objective
We aimed to report the treatment approaches we
administered to the patients admitted to our clinic for
odontoid fracture, accompanied by literature.
Material and Methods
Eighteen patients with odontoid fracture who admitted
to our clinic were evaluated retrospectively. Six
patients were female, twelve patients were male and
the mean age was 45,5 (16-87). Type 1 fracture in
7 patients, Type 2 fracture in 4 patients and Type 3
fractures in 7 patients were determined. As 86% of the
patients with type 1 fracture, and 57% of the patients
with type 3 fracture were treated conservatively, all
patients with type 2 fracture treated with anterior
odontoid screw and in 1 patient with type 3 fracture
posterior arthrodesis was performed. Six of the
conservatively treated patients used Halo-Vest, 3 of
them used Philadelphia cervical collar, and 2 of them
used sterno-occipito-mandibular immobilizer (SOMI).
Results
Fusion was occurred in 7 patients (64%) of 11
patients, who treated conservatively, and in the 4
patients (36%) surgery was planned as non-fusion
was occurred. Two of these patients with no symptoms
did not accept surgery. In one patient, with anterior
surgery, posterior occipitocervical fusion was done as
screw malposition was seen.
Conclusion
In decision making of the odontoid fractures, type of the
fracture and age of the patient should be considered.
As deciding the surgical technique beside clinical
improvement, fusion rate is also important. In the
elder patients anterior screwing should be preferred
to conserve mobility; in the older patients posterior
fusion should be preferred not to have mechanical
deficiency and to minimize the other complications.
However appropriate treatment strategy is still not
clear.

Keywords

odontoid, odontoid screwing, conservative approach, C1-C2 arthrodesis

Project Number

Yok

References

• Robinson AL, Möller A, Robinson Y, Olerud C. C2 fracture subtypes, incidence and treatment allocation change with age: a retrospective cohort study of 233 consecutive cases. Biomed Res Int. 2017;2017:8321680.
• McMordie JH, Viswanathan VK, Gillis CC. Cervical Spine Fractures Overview. [Updated 2020 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448129/
• Beckmann NM, Chinapuvvula NR, Zhang X, West OC. Epidemiology and imaging classification of pediatric cervical spine injuries: 12-year experience at alevel 1 trauma center. AJR Am J Roentgenol 2020;214(6):1359-1368.
• Fiedler N, Spiegl UJA, Jarvers JS, Josten C, Heyde CE, Osterhoff G. Epidemiology and management of atls fractures. Eur Spine J.2020;29(10):2477-2483.
• Gornet ME, Kelly MP. Fractures of the axis: a review of pediatric, adult, and geriatric injuries. Curr Rev Musculoskelet Med. 2016;9(4):505-512.
• Guan J, Bisson EF. Treatment of odontoid fractures in the aging population. Neurosurg Clin N Am. 2017;28(1):115-123.
• Baogui L, Juwen C. Fusion rates for odontoid fractures after treatmnet by anterior odontoid screw versus posterior C1-C2 arthrodesis: a meta-analysis. Arch Orthop Trauma Surg. 2019;139(10):1329-1337.
• Modi JV, Soman SM, Dalal S. Traumatic cervical spondyloptosis of the subaxial cervical spine: a case series with a literature review and a new classification. Asian Spine J. 2016;10(6):1058-1064.
• Letaif OB, Damasceno ML, Cristante AF, Marcon RM, Iutaka AS, Oliveira RP, et al. He choice of surgical approach for treatment of cervical fractures. Coluna/Columna. 2010;9(4):358-62.
• Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56(8):1663-74.
• Marcon RM, Cristante AF, Teixeira WJ, Narasaki DK, oliveira RP, Filho TE. Fractures of the cervical spine. Clinics;2013;68(7):1455-1461.
• Smith RM, Bhandutia AK, Jauregu JJ, Shasti M, Ludwig SC. Atlas fractures: diagnosis, current treatment recommendations, and implications for elderly patients. Clin Spine Surg. 2018;31(7):278-284.
• Stein DM, Knight WA. Emergency neurological life support: traumatic spine injury. Neurocrit Care. 2017;27(1):170-180.
• Dunn ME, Seljeskog EL. Experience in the management of odontoid process injuries: an analysis of 128 cases. Neurosurgery 1986;18(3):306-10.
• Clark CR, White AA 3rd. Fractures of the dens. A multicenter study. J Bone Joint Surg Am. 1985;67(9):1340-8.
• Chapman J, Smith JS, Kopjar B, et al. The AOSpine North America Geritric Odontoid Fracture Mortality study. Spine. 2013;38:1098-1104.
• Pommier B, Ollier E, Pelletier J-B, Castel X, Vassal F, Tetard M-C. Conservative versus surgical treatment for odontoid fractures: is the surgical treatment harmful? Systemic review and meta-analysis. World Neurosurgery 2020;141:490-499.
• Konieezny MR, Gstrein A, Müller EJ. Treatment algorithm for dens fractures: non-halo immobilization, anterior screw fixation, or posterior transarticular C1-C2 fixation. J Bone Jt Surg. 2012;94:e144.
• Müller EJ, Schwinnen I, Fischer K, Wick M, Muhr G. Non-rigid immobilisation of odontoid fractures. Eur Spine J. 2003;12:522-525.
• Di Paolo A, Piccirilli M, Pescatori L, Santoro A. Single institute experience about 108 consecutive cases of type II odontoid fractures: surgery versus conservative treatment. Turk Neurosurg. 2014;24:891-896.
• Hong J, Zaman R, coy S, et al. A cohort study of the natural history of odontoid pseudoarthrosis managed nonoperatively in elderly patients. World Neurosurg. 2018;114:e1007-e1015.