1. What are the findings?
Posturally there is a left cervical convexity and a right lateral head tilt. There is slight fullness of the retropharyngeal soft tissue. Careful analysis of the open mouth views indicates asymmetric paraodontoid spaces. The appearance of the C1 lateral masses and C1-2 joint spaces also appear asymmetric. There is also a subtle lucency which extends across the base of the odontoid. These findings are indicative of a C2 fracture. No spondylolisthesis is identified. There is marked right facet arthrosis at C4-5.
2. Which of the following steps would be appropriate care?
Odontoid Process Fractures - Discussion
Fractures of the odontoid process are most commonly the result of flexion injuries, although in rare circumstances they may result from a hyperextension injury. Hyperflexion fractures will often cause anterior displacement of the dens in relation to the body of C2. There are different types of odontoid process fractures with treatment varying depending on the type of fracture. The most common system of classifying dens fractures is as follows:
TYPE I - Fracture through the body of the dens. This type of fracture is considered stable and is usually treated conservatively, usually by cervical immobilization for 6-8 weeks.
TYPE II - Transverse fracture through the base of the dens. This fracture is considered unstable. Treatment may be performed conservatively with halo immobilization. However, if treated conservatively approximately 1/3 will result in non union and therefore surgical fusion is often performed.
TYPE III - Fracture through the base of the odontoid which extends into the body of C2. Considered to be stable inuries, these are often treated conservatively with halo immobilization and/or surgical fixation.
Below is the CT for this patient.
Posturally there is a left cervical convexity and a right lateral head tilt. There is slight fullness of the retropharyngeal soft tissue. Careful analysis of the open mouth views indicates asymmetric paraodontoid spaces. The appearance of the C1 lateral masses and C1-2 joint spaces also appear asymmetric. There is also a subtle lucency which extends across the base of the odontoid. These findings are indicative of a C2 fracture. No spondylolisthesis is identified. There is marked right facet arthrosis at C4-5.
2. Which of the following steps would be appropriate care?
- additional imaging such as CT or MRI
- hard cervical collar
- spinal manipulation or physical therapy
Odontoid Process Fractures - Discussion
Fractures of the odontoid process are most commonly the result of flexion injuries, although in rare circumstances they may result from a hyperextension injury. Hyperflexion fractures will often cause anterior displacement of the dens in relation to the body of C2. There are different types of odontoid process fractures with treatment varying depending on the type of fracture. The most common system of classifying dens fractures is as follows:
TYPE I - Fracture through the body of the dens. This type of fracture is considered stable and is usually treated conservatively, usually by cervical immobilization for 6-8 weeks.
TYPE II - Transverse fracture through the base of the dens. This fracture is considered unstable. Treatment may be performed conservatively with halo immobilization. However, if treated conservatively approximately 1/3 will result in non union and therefore surgical fusion is often performed.
TYPE III - Fracture through the base of the odontoid which extends into the body of C2. Considered to be stable inuries, these are often treated conservatively with halo immobilization and/or surgical fixation.
Below is the CT for this patient.
The CT scan shows the fracture extending across the base of the odontoid process and into the left transverse process of C2 and left foramen transversarium. This is an important distinction as C2 fractures that extend to the foramen, demonstrate displaced fracture fragments within the foramen, or show significant angulation of the fracture fragments are at increased risk for associated vertebral artery injury.