The treatment of concomitant odontoid fracture and lower cervical spine injuries

Study Design. A retrospective study. Objective. To investigate the treatment of odontoid fractures combined with lower cervical spinal injury. Summary of Background Data. Odontoid fractures combined with a lower cervical spinal injury are rarely reported in the literature and their incidence and characteristics are not well known. Methods. Seventy-six patients with type II shallow type III odontoid fractures were studied retrospectively. Nine odontoid fractures were found combined with lower cervical spinal injuries; the mean age of patients was 56.8 years. For lower cervical spinal injuries, dislocation was found in 4 patients and disruption of the disc and ligament was found in 5 patients. All patients received surgical management for the odontoid fracture and lower cervical spinal injury in the same operative session. Surgical priority was decided based on neurologic complications, segmental instability, and reducibility of the luxated lower cervical spine. For 3 quadriparetic patients, surgical priority was given to their spinal injuries. For the other 6 patients without neurologic deficits, surgical priority was given to the odontoid fractures in 5 patients because of successful reduction of the dislocation or nondislocation in the lower cervical spine; surgical priority was given to an irreducible lower cervical spine dislocation in the remaining patient. Results. After an average follow-up period of 18 months, there were no complications and all patients showed fusion both in the odontoid fracture and the lower cervical spinal injury. Three patients with a neurologic deficit improved by 1 or 2 grades on the ASIA scale. Conclusion. In this series, 9 of 76 (12%) of patients with odontoid fractures also had a lower cervical spinal injury. Surgical stabilization was the choice of treatment as it facilitated early rehabilitation and reduced complications. We propose a new algorithm for treatment according to neurologic complications, segmental instability, and reducibility of the luxated lower cervical spine.