A six year review of odontoid fractures: The emerging role of surgical intervention

Background: Traditionally, odontoid fractures have been treated with differ ent bracing techniques resulting in variable degrees of successful healing. Surgical intervention is becoming more widely practiced as a primary inter vention. The purpose of this report was to survey our recent experience in southern Alberta to determine potential outcome differences in management s trategies. Methods: We retrospectively reviewed the charts of 520 patients diagnosed with cervical spine fractures over a six-year period from January 1990, through December 1996. Patients were identified through the medical records database of the two Level 1 trauma facilities, on the basis of ICD- 9 diagnostic coding. Results: Ninety-three fractures of the odontoid proces s were identified, of which 85 were acute and eight were chronic. There wer e 57 Type II (67%) and 27 Type III (32%) acute odontoid fractures. Of these , 64 were managed conservatively (bracing), whereas 20 were treated surgica lly. Thirteen patients underwent anterior screw fixation, seven patients ha d posterior cervical fusion, Eleven patients died in the acute phase, two a s a result of their high cervical cord injury and nine from unrelated medic al causes. Fifty-six of the remaining 82 patients (68%) were located with a minimum of three months follow-up (range three months to eight years). Sat isfactory results were obtained in 76% of all acute patients treated by bra cing, but only 50% in those over the age of 65. In the surgically managed g roup, all patients (100%) went on to develop stable fusions, Conclusions: O ur results indicate that while conservative management of odontoid fracture s with external bracing results in fracture healing in most cases, surgical fusion may provide superior rates of bony union with acceptable morbidity. This difference in outcome lends itself to formal investigation through a prospective randomized trial.