gms | German Medical Science

Objective: Odontoid fractures account for more than 10% of all cervical fractures. Only little is known about the incidence and outcome of neurological impairments caused by this type of injury. This study will report on how frequently odontoid fractures are accompanied by neurological impairments. Additionally, the outcome of the neurological deficits was observed.

Methods: In this retrospective single-center study we analyzed data from 198 patients with odontoid fractures treated between 2002 and 2016. The data was obtained from hospital records. The statistical analysis included Fisher's exact test, Welch's t-test, ANOVA-test applying an alpha-error of 5%. All statistical tests were performed using SPSS.

Results: The data of 198 patients with odontoid fractures were collected. The median patient age was 78 years and ranged between 12 and 95 years. Of these patients 117 were female (59%) and 81 male (41%).

At hospital admission, the initial clinical examination showed that 27 (13.6%) of 198 patients suffered neurological deficits due to an odontoid fracture. Of those 3 patients had minor deficits (e.g. tingling and/or limb sensations), and 24 patients had significant neurological impairments (e.g. motor weakness, gait disorders). For 26 out of the 27 patients with neurological deficits the radiological imaging (Computed tomography scans) was available. 20 patients (76.9%) suffered a type II fracture, 5 patients (19.2%) had a type III fracture and one patient of those with neurological impairments presented a type I fracture (3.9%) based on the classification system of Anderson and D'Alonzo.

16 of the 27 patients suffering neurological impairments (59.3%) were treated using anterior odontoid screw fixation (AOSF) procedure, four patients (14.8%) had received posterior immobilization and fusion techniques and seven patients (25.9%) were treated conservatively applying rigid cervical collars.

The outcome analysis revealed that 2 patients died while hospital stay. Long-term follow-up data of the 24 patients suffering severe motor deficits was available from 22 patients. After 12 months 16 of these patients had fully recovered from any neurological impairments while 6 patients showed no or incompletely improvement of the neurological status.

Conclusion: The incidence of 13.6 % of neurological deficits in odontoid fractures is remarkable. The likelihood of complete resolution of initial neurological deficits within one year is 73 %. Age, sex and surgical techniques have no impact on outcome