Treatment of Odontoid Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)

被引:38
作者
Gonschorek, Oliver [1 ]
Vordemvenne, Thomas [2 ]
Blattert, Thomas [3 ]
Katscher, Sebastian [4 ]
Schnake, Klaus John [5 ]
机构
[1] BGU Trauma Ctr, Murnau, Germany
[2] Evangel Klinikum, Burgsteig, Germany
[3] Orthopad Fachklin Schwarzach, Schwarzach, Germany
[4] Sana Klinikum Borna, Borna, Germany
[5] Schon Klin Nurnberg Furth, Furth, Germany
关键词
odontoid fracture; operative treatment; Anderson-D'Alonzo classification; anterior screw; posterior stabilization; TRANSARTICULAR SCREW FIXATION; HALO-VEST IMMOBILIZATION; NONOPERATIVE MANAGEMENT; ELDERLY-PATIENTS; DENS FRACTURES; MORTALITY; FUSION; ADULT; AXIS;
D O I
10.1177/2192568218768227
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Study Design: Narrative review. Objective: To establish recommendations for the treatment of odontoid fractures based on current literature and the knowledge of the experts of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Methods: Narrative review of the literature. Analyzing treatment algorithms of German trauma and spine centers as members of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Results: There are many influencing factors leading to appropriate treatment of odontoid fractures such as age, bone quality, arthrosis, classification, and type of the fracture. Conservative nonoperative treatment is appropriate for stable undislocated displaced odontoid fractures. Anterior osteosynthesis with 1 or 2 screws leads to good results in the classical unstable type II odontoid fracture in patients with good bone quality. However, modifiers have been identified by the working group leading to higher complication and failure rates. For these cases, more stable constructs and/or posterior approaches are indicated. Conclusions: Operation seems to be standard treatment for odontoid fractures. However, in the aged population, conservative treatment should be considered as morbidity and mortality rise significantly in the group of >75 years. Conservative treatment may also be started within stable nondislocated fractures, but then regular controls have to be performed. If operation is indicated, many influencing factors have to be considered for appropriate approach and technique. The classification of Anderson and D'Alonzo is still standard. To create an adequate treatment algorithm, dislocation displacement and instability have to be identified. Stable odontoid fractures are treated conservatively non-operatively, but if so regular controls have to be performed. Unstable and/or dislocated displaced odontoid fractures are treated by anterior osteosynthesis with 1 or 2 screws. The technique is demanding and leads to elevated complication and failure rates if modifiers are apparent. In these cases, posterior instrumentation or fusion of C1 and C2 is favorable. In the aged population (>80 years), operative therapy is critical as postoperative morbidity complication and mortality rates rise significantly. As there is still some bias in the treatment algorithms, the working group recommends establishment of a prospective study to result in more objective statements.
引用
收藏
页码:12S / 17S
页数:6
相关论文
共 36 条
  • [21] Cement-augmented anterior screw fixation of Type II odontoid fractures in elderly patients with osteoporosis
    Kohlhof, Hendrik
    Seidel, Ulrich
    Hoppe, Sven
    Keel, Marius J.
    Benneker, Lorin M.
    [J]. SPINE JOURNAL, 2013, 13 (12) : 1858 - 1863
  • [22] Management of type II dens fractures - A case-control study
    Lennarson, PJ
    Mostafavi, H
    Traynelis, VC
    Walters, BC
    [J]. SPINE, 2000, 25 (10) : 1234 - 1237
  • [23] The contemporary treatment of odontoid injuries
    Maak, Travis G.
    Grauer, Jonathan N.
    [J]. SPINE, 2006, 31 (11) : S53 - S60
  • [24] Halo vest immobilization in the elderly: A death sentence?
    Majercik, S
    Tashjian, RZ
    Biffl, WL
    Harrington, DT
    Cioffi, WG
    [J]. JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2005, 59 (02): : 350 - 356
  • [25] Nonoperative management of odontoid fractures using a halothoracic vest
    Platzer, Patrick
    Thalhammer, Gerhild
    Sarahrudi, Kambiz
    Kovar, Florian
    Vekszler, Gyoergy
    Vecsei, Vilmos
    Gaebler, Christian
    [J]. NEUROSURGERY, 2007, 61 (03) : 522 - 529
  • [26] Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know
    Riascos, Roy
    Bonfante, Eliana
    Cotes, Claudia
    Guirguis, Mary
    Hakimelahi, Reza
    West, Clark
    [J]. RADIOGRAPHICS, 2015, 35 (07) : 2122 - 2135
  • [27] C2 dens fractures: Treatment options
    Sasso, RC
    [J]. JOURNAL OF SPINAL DISORDERS, 2001, 14 (05): : 455 - 463
  • [28] Cement-Augmented Anterior Odontoid Screw Fixation of a Anderson-D'Alonzo Type II Fracture with Massive Osteoporosis. Case Report
    Scholz, M.
    Schnake, K. J.
    Hoffmann, R.
    Kandziora, F.
    [J]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE, 2011, 149 (03): : 308 - 311
  • [29] A meta-analysis of the fusion rate from surgical treatment for odontoid factures: anterior odontoid screw versus posterior C1-C2 arthrodesis
    Shen, Ye
    Miao, Jinhao
    Li, Chao
    Fang, Lei
    Cao, Samantha
    Zhang, Ming
    Yan, Jianhua
    Kuang, Yong
    [J]. EUROPEAN SPINE JOURNAL, 2015, 24 (08) : 1649 - 1657
  • [30] 3D Fluoroscopy-Navigated Magerl Fusion of the 1st and 2nd Cervical Vertebra
    Stein, G.
    Schiffer, G.
    Bredow, J.
    Meyer, C.
    [J]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE, 2016, 154 (06): : 636 - 637