Fractured odontoid: The management of delayed neurological symptoms

David Fairholm, Shih Tseng Lee, Tai Nyar Lui

研究成果: 雜誌貢獻文章同行評審

35 引文 斯高帕斯(Scopus)


UNDIAGNOSED AND UNTREATED odontoid fractures are relatively common in developing countries where treatment for minor injuries is not considered. As a result, patients frequently present with neurological deterioration secondary to delayed odontoid dislocation. Fifty-one consecutive patients with this problem were entered into a management protocol and reviewed for this report. After diagnosis, reducibility was analyzed by extension films, and all patients who could not be reduced were initially managed in cranial tong traction. Thirty-seven were reduced spontaneously or by traction alone, and 12 required transoral decompression. All underwent posterior C1-C2 fusion. Postoperatively, all were treated in external orthoses. The neurological recovery was excellent in 34 patients. Seven patients could function but had some disability, three patients had disabling spasticity, and three remained bedridden. Four deaths occurred as a result of respirator- dependent patients being taken home for social and financial reasons. As a result of this case-controlled study, we recommend that the treatment protocol first analyze reducibility by extension x-rays and then try traction for as long as 14 days to attempt reduction in patients who did not reduce in extension. Failure of reduction is indication for transoral decompression, and all patients require C1-C2 fusion. The neurological recovery is related to initial impairment but can be satisfactory in >75% of patients.

頁(從 - 到)38-43
出版狀態已發佈 - 1月 1996

ASJC Scopus subject areas

  • 手術
  • 神經病學(臨床)


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