Anterior odontoid screw osteosynthesis

Prior to joining Rothman Orthopaedic Institute, she worked as an emergency trauma center physician assistant at a local teaching hospital.

Anterior odontoid screw osteosynthesis

Dens is a strong, tooth-like process projecting upwards from the body of axis. These fractures occur in young patients and elderly in a bimodal fashion. Whereas inyoung patients the fractures are as a result of blunt trauma to head leading to cervical hyperflexion or hyperextension, in elderly people these occur by simple fall.

Elderly people also have higher morbidity and mortality. Cartilagenous junction between the dens and vertebral body that does not fuse until 6 years of age and should be kept in mind so as not to misdiagnose it as fracture.

Range of Motion of Cervical Spine Occipital-C1-C2 ligamentous stability is provided by the odontoid process and its supporting ligaments. Transverse ligament limits anterior translation of the atlas.

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Both apical ligaments and alar ligaments limit rotation of the upper cervical spine The odontoid is derived from mesenchyme of the first cervical vertebra. During development, it becomes separated from the atlas and fuses with the axis. The apex, or tip, of the odontoid is derived from the most caudal occipital sclerotomeor proatlas.

Blood Supply Of Odontoid Vertebral and carotid arteries form the main source of blood supply to odontoid.

Cleft perforators come fron of the extracranial internal carotid artery and supply the superior portion of the odontoid.

Anterior odontoid screw osteosynthesis

Os Odontoideum This condition was earlier thought to be a failure of fusion at base of the odontoid but new evidence has suggested likelihood of residual old traumatic process.

An os odontoduem can be divided into two main types Orthotopic: Anterior displacement is associated with transverse ligament failure and atlanto-axial instability. Posterior displacement is caused by direct impact from the anterior arch of atlas during hyperextension.

These are usually stable fractures but may be associated with atlanto-occipital dislocation. Generally it is a stable fracture.

Fractures occur at the base. These fractures are associated with higher rate of non union. Fractures occur through the body of C2 and does not actually involve dens. These are unstable fracture as the atlas and occiput can now move together as a unit Presentation Patients present with neck pain that worsens with motion of the neck.

Other findings may be Motor power loss ranging to quadriplegia Feeling of instability of head on spine Dysphagia may be present when associated with a large retropharyngeal hematoma Imaging Xrays AP, lateralopen-mouth odontoid view of cervical spine are commonly done in injury to upper cervical spine and odontoid fractures.

Fracture pattern is best seen on open-mouth odontoid. Flexion extension radiographs are important to diagnose occipitocervical instability in Type I odontoid fractures and Os odontoideum. CT angiogram is required to determine location of vertebral artery prior to posterior instrumentation procedures.

MRI is indicated if neural loss is there. Treatment Overview Os Odontoideum patients require observation in most of the cases. Type I fractures are managed by cervical orthosis. Otherwise they should be operated.

HPI - The patient is an year-old female that was involved in a MVA and sustained a Type 2 odontoid fracture. An initial attempt at nonoperative treatment with a hard cervical orthosis was attempted for three weeks. However, the patient had continued severe pain in the neck, and was having. Upwards of 50% of motion occurs in the upper cervical spine, consisting of the occiput, atlas, and axis. 2 The atlas, or C1, is the first of 7 cervical vertebrae and is responsible for transmitting loads from the skull to the cervical spine. It is unique in that its vertebral body is . Fractures of the axis and atlas are most often encountered in children and in those aged > The osseoligamentous complex that protects the upper cervical spine is anatomically and functionally distinct from those of the subaxial cervical spine.

In elderly patients who are not candidates for surgery, type II fractures are managed with cervical orthoses. Hard Cervical Orthosis These are worn for weeks in patients with type I and type II in elderly who are not surgical candidates.

Union may not occur in these cases but a fibrous union provides enough stability. Halo Vest Immobilization It is done in young patients with no risk factors for nonunion. This is also worn for weeks. Surgical Treatment Posterior C1-C2 fusion This involves fusion of first and second vertebra posteriorly.

This treatment is considered in patients with Type II fractures with risk factors for nonunion. This is done in patients with type II fractures with risk factors for nonunion and acceptable alignment and minimal displacement provided fracture pattern allow proper screw placement.

It is associated with higher failure rates than posterior C fusion Transoral Odontoidectomy Odontoid is removed when there is severe posterior displacement of dens with spinal cord compression and neurologic deficits Image Credit: Thank you for subscribing.

We respect your privacy and take protecting it seriously Spread the Knowledge.Hintergrund Etwa 30 % aller Verletzungen der Halswirbelsäule betreffen Atlas und Axis.

Odontoid Fracture (Adult and Pediatric) - Spine - Orthobullets

Frakturen kommen vorwiegend bei älteren Patienten vor, während ligamentäre Verletzungen öfter in jüngeren. As part of the Rothman Orthopaedic Institute’s Joint Replacement Program, one of the nation’s top programs, Alexander R.

Vaccaro, M.D., . Dr. Thomas Wieland, Orthopädie und orthopädische Chirurgie – Unfallchirurgie. Spezialgebiet - Schulter, Hüfte und Knie. Mödling, Baden und Wien.

Odontoid Fracture (Adult and Pediatric) - Spine - Orthobullets

HPI - The patient is an year-old female that was involved in a MVA and sustained a Type 2 odontoid fracture. An initial attempt at nonoperative treatment with a hard cervical orthosis was attempted for three weeks.

However, the patient had continued severe pain in the neck, and was having. Upwards of 50% of motion occurs in the upper cervical spine, consisting of the occiput, atlas, and axis. 2 The atlas, or C1, is the first of 7 cervical vertebrae and is responsible for transmitting loads from the skull to the cervical spine.

It is unique in that its vertebral body is . Upwards of 50% of motion occurs in the upper cervical spine, consisting of the occiput, atlas, and axis. 2 The atlas, or C1, is the first of 7 cervical vertebrae and is responsible for transmitting loads from the skull to the cervical spine.

It is unique in that its vertebral body is .

Cervical Spine Trauma Evaluation - Spine - Orthobullets