Romanian Neurosurgery (Nov 2024)
FRACTURES OF THE DENS
Abstract
Introduction The odontoid process has a peg-like conformation of the C2 vertebra. Fractures of the dens represent about 15% of all cervical injuries. The most common appears due to hyperextension of the neck, in older patients. The most obvious complication is nonunion, also high mortality in older patients. Material and Methods This retrospective study was created with medical records of 105 patients during 3 years, being gathered from the database of EHBA. Our series consisted of 65 males, 40 females, with the average age between 70-90. Data collection involved frequency of appearing cases depending on the season of the year, Frankel scale, type of fracture, the circumstances of the occurrence of the fracture, associated injuries, alcohol consumption and type of treatment. Also, was exemplified this topic through clinical cases, with pre- and postoperative status. Surgical procedures included philodesis C1-C2. Conservative treatment was tried for type I and III fractures. Results During 3 years, the most cases were in 2023, especially in autumn season. From all types of fractures - the most frequent was type II with dislocation, the least common was type I. The circumstances of the occurrence of the fractures included fall from the same level, from another level, also due to road accidents. According Frankel scale, about 73 cases were Frankel D and E, and only 6 cases were Frankel A. Besides this, were associated other injuries, cranio-facial lesions, other spinal lesions, thoracic and abdomino-pelvic injuries. A lot of cases were related with alcohol consumption - 22 cases. Surgical procedures included 26 cases, others -conservative option. Moreover, I considered a lot of clinical cases, and I mentioned imagistic section and their evolution accordingly type of treatment. Conclusions The dens fractures are quite frequent of the axis, especially in elderly patients, in low energy falls. Treatment varies on the type of fracture and risk factors for nonunion - philodesis C1-C2 or nonoperative technique. Unfortunately - there are few symptoms, many cases don’t have neurologic deficits, being missed the diagnosis of these fractures. Furthermore, many cases were polytraumatic, that needed a multidisciplinary team.
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