Odontoid Fractures Surgical Management by Fusion COA

Description: Approximately fifty percent of axial rotation of the cervical spine occurs at the C1-C2 articulation. Instability at this level occurs most commonly as a result of fractures of the odontoid or bursting injuries of the atlas with disruption of the transverse ligament. The goal in the treatment is 1) to reestablish the normal anatomic relationships at the level or the ring of C1 and 2) to maintain them either through osteosynthesis of the dens or through a solid fusion of C1 and C2. The theoretical advantage of osteosynthesis of the dens is to maintain this motion. However, due to scarring of the transverse ligament related to the injury itself and with anything less than anatomical alignment of the odontoid process, there may be loss of C1-C2 motion despite one's best efforts. Inability to achieve anatomical alignment also precludes direct fixation of the dens. This technique is also contraindicated in patients with osteoporosis, nonunion, os odontoideum or thoracic kyphosis. The role of fusion for odontoid fractures is well established and a number of techniques are available to achieve the goals of treatment in a safe and effective manner.
Joel Finkelstein, M.D., FRCSC COA Bulletin Issue 81 2008