Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid im...Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.展开更多
Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysi...Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.展开更多
Odontoid fracture accounts for 15%<span> - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture </span><span>is</span><span> the most commo...Odontoid fracture accounts for 15%<span> - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture </span><span>is</span><span> the most common variety. This injury is associated with a high incidence of morbidity, mortality and nonunion in </span><span>the </span><span>elderly irrespective of mode of treatment. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still ha</span><span>s</span><span> some controversial issues. Objective of this review is to find </span><span>a </span><span>controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words</span><span>: </span><span>odontoid, fracture, type-2, management, nonoperative and operative management. Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. Though surgical treatment has </span><span>a </span><span>better outcome</span><span>, it </span><span>is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Conservative treatment of this fracture in </span><span>the </span><span>elderly should preferably be carried out with hard collar or avoiding halo vest. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy.</span>展开更多
文摘Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type Ⅱ fractures are the most common fracture pattern in elderly patients. Treatment(rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type Ⅱ odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid nonunion successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.
文摘Objectives: To explore the treatment and related prognosis of elderly patients with Anderson II odontoid fracture with posterior pedicle screw fixation combined with iliac bone grafting. Methods: Retrospective analysis of 17 cases of elderly patients with Anderson II odontoid fracture who underwent posterior pedicle screw fixation combined with iliac bone grafting from January 2013 to December 2016. 17 patients had a history of trauma before surgery, and they all have varying degrees of atlantoaxial instability or subluxation and varying degrees of neck occipital pain and limited mobility. Result: No spinal cord or vertebral artery injury occurred during surgery. Follow-up information is complete. The follow-up period was 6 to 48 months (mean 27.4 ± 12.4 months). Postoperative imaging review prompted a good reduction of cervical spine, stable sequence;no pedicle screw loosening, fracture, iliac bone graft at the location of the situation, odontoid fracture and bone healing at the good, the patient after cervical rotation are limited to varying degrees. Conclusion: Posterior pedicle screw fixation combined with iliac bone grafting in elderly patients with Anderson II odontoid fracture can achieve good stability, and the prognosis is good, but long-term cervical rotation function may be affected to varying degrees.
文摘Odontoid fracture accounts for 15%<span> - 20% of all cervical spine injuries. Among the odontoid fracture, type-2 fracture </span><span>is</span><span> the most common variety. This injury is associated with a high incidence of morbidity, mortality and nonunion in </span><span>the </span><span>elderly irrespective of mode of treatment. Management of odontoid fracture cannot be standardized till to date and ideal treatment for type-2 odontoid fractures still ha</span><span>s</span><span> some controversial issues. Objective of this review is to find </span><span>a </span><span>controversial aspect of management along with opinion to find out a standard guideline by searching the literature in Pubmed and Google scholar databases with key words</span><span>: </span><span>odontoid, fracture, type-2, management, nonoperative and operative management. Nonoperative treatment with halo vest is associated with very high rate of complication in elderly patient. When conservative treatment of this fractures is indicated that should be carried out with hard cervical collar or cervicothoracic orthosis. Current studies suggest that surgical management of odontoid fractures may offer a protective benefit but it is limited to patients younger than 75 years of age. Though surgical treatment has </span><span>a </span><span>better outcome</span><span>, it </span><span>is also limited by the co-mobidities and hazards of anesthesia and surgery in elderly patients. Conservative treatment of this fracture in </span><span>the </span><span>elderly should preferably be carried out with hard collar or avoiding halo vest. Surgical treatment is associated with little advantage but should be selected with proper attention to age, comorbidities, fracture geometry and it is better to individualize the treatment strategy.</span>
