![]() ![]() Cervical spine stability was achieved either by bone fusion or by fibrous union. Nine of the 10 patients treated with a rigid cervical collar had good results. Two specific tests of long-term function were used: the Neck Disability Index and the Smiley-Webster Scale. Function included neck range-of-motion and ability to perform daily activities. Pain and function were two other outcome measures used to compare patient results with conservative care. X-rays were taken to see if bone fusion had taken place. Sometimes the halo brace is referred to as a halo vest.īracing was used for 12 to 24 weeks. This vest offers the weight to anchor the ring and immobilize the neck. Four metal bars attach the halo ring to a vest worn on the chest. This portion of the brace is secured to the skull by metal screws (pins). The halo brace is a titanium ring (the halo) that goes around the head. Results were compared for 10 patients who used the cervical collar and 32 patients who were placed in a halothoracic brace. The two most common forms of immobilizers used in this study included a rigid cervical collar and a halothoracic brace. If the atlas and axis have not been displaced (moved), then immobilizing the neck for a period of time is an option. Surgery is indicated in cases of nonunion instability such as recurrent dislocation or when there is serious neurologic involvement (e.g., paralysis). If conservative care fails, then surgery to fuse the spine can be done. In fact, this approach is preferred because of known complications that occur when surgery is done for this problem in older adults. Nonoperative treatment to allow the bone to knit back together can be successful. Type II odontoid fractures are unstable because they can be displaced so easily. The spinal canal is a round opening or hollow tube formed by the vertebrae stacked on top of each other. This puts a tremendous compressive or stretching force on the spinal cord as it goes down through the spinal canal. Without this piece of bone in place, the first two vertebral bones (the atlas and the axis) can slide apart. The joints of the axis give the neck most of its ability to turn to the left and right.Ī Type II odontoid fracture occurs right where the odontoid process attaches to the C2 vertebral body. The dens points up and fits through a hole in the first cervical vertebra (called the atlas). The odontoid process is also called the dens. The odontoid is a bony knob or upward projection of bone on top of the second cervical vertebra (C2). This type of fracture is most common in older adults who fall and break off the odontoid in the cervical spine (neck). Everyone in the study was at least 65 years old. Researchers from Australia present the positive results of 42 patients with a Type II odontoid (neck) fracture who were treated conservatively (without surgery). These findings may prove useful for patients who are not surgical candidates or elect for nonoperative treatment.Physical Therapy in California South Bay for Upper Back and Neck Patients with nonunion did not report worse outcomes compared with those who achieved union at 12 months however, the majority of patients with nonunion required delayed surgical treatment. Nonoperative treatment for type II odontoid fracture in the elderly has high rates of nonunion and mortality. For union and nonunion groups, Neck Disability Index and SF-36 version 2 declined significantly at 12 months compared with preinjury values (P 0.05) however, it is important to emphasize that the 12-month outcomes for the nonunion patients reflect the status of the patient after delayed surgical treatment in the majority of these cases. The overall 12-month mortality was 14.0% (nonunion = 2, union = 5 P= 0.6407). Thus, 15 (30.0%) patients developed primary or secondary nonunion and 11 (22.0%) required surgery. Four of the 39 (10.3%) patients classified as having "successful union" required surgery due to late fracture displacement. Of the remaining 50 patients, 11 (22.0%) developed nonunion, with 7 (63.6%) requiring surgery. Of the 58 patients initially treated nonoperatively, 8 died within 90 days and were excluded. Fifty-eight (36.5%) of the 159 patients were treated nonoperatively. Neck Disability Index and Short-Form 36 (SF-36) version 2 were collected at baseline and 6 and 12 months. Subgroup analysis of a prospective multicenter study of elderly patients (≥65 yr) with type II odontoid fracture. Odontoid fractures are among the most common fractures in the elderly, and controversy exists regarding treatment. Outcome analysis of nonoperatively treated elderly patients with type II odontoid fractures, including assessment of consequence of a fracture nonunion. Subgroup analysis of a prospective multicenter study. ![]()
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