Nonoperative management of odontoid fractures: A review of 59 cases

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.