Rizk Elias, Kelleher John Paul, Zalatimo Omar, Reiter Timothy, Harbaugh Robert, McInerney James, Sheehan Jonas
Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, USA.
Clin Neurol Neurosurg. 2013 Sep;115(9):1653-6. doi: 10.1016/j.clineuro.2013.02.017. Epub 2013 Mar 28.
Surgical treatment of odontoid fractures is recommended by many surgeons to prevent sudden neurologic injury or progressive myelopathy. Less aggressive approach to the treatment of odontoid fractures has been advocated by some authors especially in the elderly population. Very few reports have followed up patients' outcomes following conservative treatment of odontoid fractures. Here we evaluate the clinical and radiographic results of patients without myelopathy treated without surgery for an odontoid type fracture.
101 patients with traumatic odontoid fracture admitted to the Pennsylvania State Hershey Medical Center between 1998 and 2008. Fractures were defined using a CT scan according to the Anderson-D'Alonzo Classification. Conservative treatment was pursued in appropriately selected patients.
Fifty-nine patients were selected to be treated in a cervical collar. Sixteen patients failed using radiographic evidence and continued neck pain. Fourteen patients went on to be surgically stabilized. The other two patients opted to continue with cervical orthosis and regular clinical evaluations. The Forty-three remaining patients had stable imaging studies and with no other complaints. None of the patients developed myelopathy symptoms during the follow-up period.
Our results indicate that a select group of patients with odontoid fracture who are deemed stable on initial evaluation in a cervical orthosis may be effectively managed non-operatively. None of the patients who were managed conservatively had clinical worsening during the period of management. The decision to proceed with surgical treatment was based on failure of resolution of neck pain or worsening or concerning instability on imaging studies. However in many patients, even elderly patients in a surgical risks are greater, many odontoid fractures can be safely managed in a cervical orthosis.
许多外科医生推荐采用手术治疗齿状突骨折，以预防突然的神经损伤或进行性脊髓病。一些作者主张采用不太积极的方法治疗齿状突骨折，尤其是在老年人群中。很少有报告对齿状突骨折保守治疗后的患者预后进行随访。在此，我们评估了未合并脊髓病的齿状突骨折患者非手术治疗的临床和影像学结果。
1998年至2008年间，101例创伤性齿状突骨折患者入住宾夕法尼亚州立大学赫尔希医学中心。根据Anderson-D’Alonzo分类法，通过CT扫描确定骨折类型。对适当选择的患者进行保守治疗。
59例患者选择使用颈托治疗。16例患者因影像学证据显示治疗失败且持续存在颈部疼痛。14例患者随后接受了手术固定。另外2例患者选择继续使用颈椎矫形器并定期进行临床评估。其余43例患者影像学检查结果稳定且无其他不适主诉。随访期间，所有患者均未出现脊髓病症状。
我们的结果表明，一组经初步评估在颈椎矫形器中被认为稳定的齿状突骨折患者可以有效地进行非手术治疗。所有接受保守治疗的患者在治疗期间临床症状均未恶化。决定进行手术治疗的依据是颈部疼痛未缓解、影像学检查显示病情恶化或出现令人担忧的不稳定情况。然而，在许多患者中，即使是手术风险较大的老年患者，许多齿状突骨折也可以通过颈椎矫形器安全地进行治疗。
