Abstract
Objectives: Surgical treatment of odontoid fractures is recommended by many surgeons to prevent sudden neurologic injury or progressive myelopathy. Less aggressive approach to the treatment of odontoid fractures has been advocated by some authors especially in the elderly population. Very few reports have followed up patients' outcomes following conservative treatment of odontoid fractures. Here we evaluate the clinical and radiographic results of patients without myelopathy treated without surgery for an odontoid type fracture. Patients and methods: 101 patients with traumatic odontoid fracture admitted to the Pennsylvania State Hershey Medical Center between 1998 and 2008. Fractures were defined using a CT scan according to the Anderson-D'Alonzo Classification. Conservative treatment was pursued in appropriately selected patients. Results: Fifty-nine patients were selected to be treated in a cervical collar. Sixteen patients failed using radiographic evidence and continued neck pain. Fourteen patients went on to be surgically stabilized. The other two patients opted to continue with cervical orthosis and regular clinical evaluations. The Forty-three remaining patients had stable imaging studies and with no other complaints. None of the patients developed myelopathy symptoms during the follow-up period. Conclusions: Our results indicate that a select group of patients with odontoid fracture who are deemed stable on initial evaluation in a cervical orthosis may be effectively managed non-operatively. None of the patients who were managed conservatively had clinical worsening during the period of management. The decision to proceed with surgical treatment was based on failure of resolution of neck pain or worsening or concerning instability on imaging studies. However in many patients, even elderly patients in a surgical risks are greater, many odontoid fractures can be safely managed in a cervical orthosis.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1653-1656 |
| Number of pages | 4 |
| Journal | Clinical Neurology and Neurosurgery |
| Volume | 115 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2013 |
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All Science Journal Classification (ASJC) codes
- Surgery
- Clinical Neurology
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Nonoperative management of odontoid fractures : A review of 59 cases. / Rizk, Elias; Kelleher, John Paul; Zalatimo, Omar; Reiter, Timothy; Harbaugh, Robert; McInerney, James; Sheehan, Jonas.
In: Clinical Neurology and Neurosurgery, Vol. 115, No. 9, 01.09.2013, p. 1653-1656.Research output: Contribution to journal › Article
TY - JOUR
T1 - Nonoperative management of odontoid fractures
T2 - A review of 59 cases
AU - Rizk, Elias
AU - Kelleher, John Paul
AU - Zalatimo, Omar
AU - Reiter, Timothy
AU - Harbaugh, Robert
AU - McInerney, James
AU - Sheehan, Jonas
PY - 2013/9/1
Y1 - 2013/9/1
N2 - Objectives: Surgical treatment of odontoid fractures is recommended by many surgeons to prevent sudden neurologic injury or progressive myelopathy. Less aggressive approach to the treatment of odontoid fractures has been advocated by some authors especially in the elderly population. Very few reports have followed up patients' outcomes following conservative treatment of odontoid fractures. Here we evaluate the clinical and radiographic results of patients without myelopathy treated without surgery for an odontoid type fracture. Patients and methods: 101 patients with traumatic odontoid fracture admitted to the Pennsylvania State Hershey Medical Center between 1998 and 2008. Fractures were defined using a CT scan according to the Anderson-D'Alonzo Classification. Conservative treatment was pursued in appropriately selected patients. Results: Fifty-nine patients were selected to be treated in a cervical collar. Sixteen patients failed using radiographic evidence and continued neck pain. Fourteen patients went on to be surgically stabilized. The other two patients opted to continue with cervical orthosis and regular clinical evaluations. The Forty-three remaining patients had stable imaging studies and with no other complaints. None of the patients developed myelopathy symptoms during the follow-up period. Conclusions: Our results indicate that a select group of patients with odontoid fracture who are deemed stable on initial evaluation in a cervical orthosis may be effectively managed non-operatively. None of the patients who were managed conservatively had clinical worsening during the period of management. The decision to proceed with surgical treatment was based on failure of resolution of neck pain or worsening or concerning instability on imaging studies. However in many patients, even elderly patients in a surgical risks are greater, many odontoid fractures can be safely managed in a cervical orthosis.
AB - Objectives: Surgical treatment of odontoid fractures is recommended by many surgeons to prevent sudden neurologic injury or progressive myelopathy. Less aggressive approach to the treatment of odontoid fractures has been advocated by some authors especially in the elderly population. Very few reports have followed up patients' outcomes following conservative treatment of odontoid fractures. Here we evaluate the clinical and radiographic results of patients without myelopathy treated without surgery for an odontoid type fracture. Patients and methods: 101 patients with traumatic odontoid fracture admitted to the Pennsylvania State Hershey Medical Center between 1998 and 2008. Fractures were defined using a CT scan according to the Anderson-D'Alonzo Classification. Conservative treatment was pursued in appropriately selected patients. Results: Fifty-nine patients were selected to be treated in a cervical collar. Sixteen patients failed using radiographic evidence and continued neck pain. Fourteen patients went on to be surgically stabilized. The other two patients opted to continue with cervical orthosis and regular clinical evaluations. The Forty-three remaining patients had stable imaging studies and with no other complaints. None of the patients developed myelopathy symptoms during the follow-up period. Conclusions: Our results indicate that a select group of patients with odontoid fracture who are deemed stable on initial evaluation in a cervical orthosis may be effectively managed non-operatively. None of the patients who were managed conservatively had clinical worsening during the period of management. The decision to proceed with surgical treatment was based on failure of resolution of neck pain or worsening or concerning instability on imaging studies. However in many patients, even elderly patients in a surgical risks are greater, many odontoid fractures can be safely managed in a cervical orthosis.
UR - http://www.scopus.com/inward/record.url?scp=84887621136&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84887621136&partnerID=8YFLogxK
U2 - 10.1016/j.clineuro.2013.02.017
DO - 10.1016/j.clineuro.2013.02.017
M3 - Article
C2 - 23541508
AN - SCOPUS:84887621136
VL - 115
SP - 1653
EP - 1656
JO - Clinical Neurology and Neurosurgery
JF - Clinical Neurology and Neurosurgery
SN - 0303-8467
IS - 9
ER -