Clinical Review
Treatment of Displaced Type II Odontoid Fractures in Elderly Patients
Am J Orthop. 2009 August;38(8):410-416
Author and Disclosure Information
Hossein Elgafy, MD, MCh, FRCSEd, FRCSC, Marcel F. Dvorak, MD, FRCSC, Alexander R. Vaccaro, MD, PhD, and Nabil Ebraheim, MD
Dr. Elgafy is Assistant Professor, Department of Orthopaedics, University of Toledo Medical Center, Toledo, Ohio.
Dr. Dvorak is Associate Professor, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Dr. Vaccaro is Professor, Department of Orthopaedics, Thomas Jefferson University and Rothman Institute, Philadelphia, Pennsylvania.
Dr. Ebraheim is Professor, Department of Orthopaedics, University of Toledo Medical Center, Toledo, Ohio.
Odontoid fractures are the most common cervical spine fractures for patients older than 70 years and are the most common of all spinal fractures for patients older than 80. Type II fracture, the most common type of odontoid fracture, is considered relatively unstable. It occurs at the base of the odontoid between the level of the transverse ligament and the C2 vertebral body.
In the geriatric population, it is important to look for any associated clinical comorbidities that might affect management. Treatment options for displaced odontoid fractures can be conservative or surgical. Conservative management includes immobilization in a cervical collar or in a halo vest. External immobilization with a cervical collar has had inconsistent results. Halo vest immobilization in the elderly is associated with a significant nonunion rate and several complications.
Generally accepted surgical indications are polytrauma, neurologic deficit, associated unstable subaxial spine injury that requires surgical fixation, and symptomatic nonunion. Surgical management includes either anterior odontoid screw fixation or posterior C1–C2 instrumentation with fusion.