FINAL ABSTRACT

"Fractures of the Odontoid Process and their surgical approaches"

JE Vásquez et al.

Abstract

Fractures of the Odontoid are the most common type of C2 fractures but do not have a consensus treatment, therefore we performed a retrospective study which compares the anterior and posterior approach in the Odontoid Process fracture including type of fracture, neurological involvement, surgical technique, postoperative management and early patient follow up. The data were obtained of the Neurosurgical Department of the Rancagua Regional Hospital database and includes 97 patients with dens fracture between June 1998 and August 2009. According to the Anderson and D' Alonzo classification the prevalence of type I and type II was 32,9% and 62,8% respectively. Is also important to show that four patients (4,1%) had a combination of a type II fracture plus a fracture of the Atlas. The data shown that only 6% of patients with a cervical fracture was neurologically impaired before the surgery and only one patient had neurological secuelae after the procedure because of the severity of the spine injury. For the resolution of the type II fracture we performed an anterior surgical approach with a cannulated screw, for the combination of fractures a posterior C1-2 transarticular screw fixation with supplemental tension-band fixation and a conservative management for the rest of the patients (type I). The postoperative management consisted in the use of a cervical brase for 6 weeks in all cases, at least two controls made by a neurosurgeon and the use of analgesics. We conclude that the anterior approach is the first choice when a surgical resolution is needed because it has a low rate of complications, is easier to perform and is a cheap procedure, thus the most important suggestion of our study is that an accurate classification of the fracture has to be done because it provides important information about the prognosis and in a major percentage will decide whether a surgical resolution is needed and which approach is suitable for every case.

Key Words: Odontoid Process, Atlas, Anderson and D' Alonzo classification, canulated screw, cervical brase