The study was undertaken to improve an approach to treating patients with fractures of the odontoid of the C2 vertebra. Forty-nine patients were admitted to hospital for fractures of the odontoid process on January 14, 1989 to January 3, 2004. Physical, target X-ray study of the cervical spine, computed tomography of the C1-2 vertebrae, magnetic resonance imaging of the neck were performed on admission. Type II odontoid fractures were found in 17 patients, Type III in 32, of them 5 patients were observed to have an axial fracture concurrent with Jefferson's fracture. Forty-one of the 49 patients were operated on. Eight patients underwent rigid external fixation with reposition using a Halo apparatus. In all cases, a Halo apparatus was used before surgery to correct dislocation and to fix the upper cervical part of the vertebral column. According to the type of a fracture, its duration, reducibility of atlas-axial dislocation, the patient's status, the following procedures were performed: 1) posterior combined spondylodesis of the C1-C2 vertebrae (Halifax braces) alone and in combination with transpharyngeal resection of the odontoid process; 2) transdental spiral fixation; 3) occipital spondylodesis; 4) isolated Halo reposition and fixation. In all the cases, the results of treatment were assessed as good. The effect of reposition and stabilization was achieved. The prehospital pain syndrome and neurological deficit virtually entirely regressed. It was concluded that active surgical policy in injuries of the upper cervical spine may yield the optimum clinical and orthopedic results that a differential approach is required to choose a method for decompression and stabilization depending on the type of an upper cervical vertebral injury.
Adolescent Adult