Document Detail


Fractured odontoid: the management of delayed neurological symptoms.
MedLine Citation:
PMID:  8747949     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 long 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 impairement but can be satisfactory in > 75% of patients.
Authors:
D Fairholm; S T Lee; T N Lui
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  38     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-09-19     Completed Date:  1996-09-19     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  38-43     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of British Columbia, Vancouver, Canada.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Child
Child, Preschool
Combined Modality Therapy
Dislocations / diagnosis,  surgery*
Female
Follow-Up Studies
Humans
Infant
Magnetic Resonance Imaging
Male
Neurologic Examination
Odontoid Process / injuries*,  pathology,  surgery
Postoperative Complications / etiology
Quadriplegia / etiology
Spinal Fractures / diagnosis,  surgery*
Spinal Fusion*
Traction
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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