Neurologic injury because of trauma after Type II odontoid nonunion

Odontoid fractures have been reported to represent between 9% and 19% of cervical spine fractures and are most common in the elderly. Despite the location of the fracture in the proximal cervical spine, where a spinal cord injury can be devastating, neurologic deficit after odontoid fracture is uncommon, although the overall complication rate remains high. The incidence of neurologic deficit after odontoid fracture has been reported to range from 13% to 25%, with tetraparesis seen in only 2% to 8.5%, likely because of the relatively capacious spinal canal in the upper cervical region adjacent to the odontoid process.

The authors aimed to assess whether some Type II odontoid fractures seen acutely are actually acute-on-chronic injuries representing old nonunions.

Patients presenting to a Level I trauma center with a Type II odontoid fracture as identified by CT scan, 30% of patients had a previously undiagnosed odontoid fracture nonunion. These patients likely sustained odontoid fractures from previous trauma that were not previously diagnosed and went on to nonunion. The rate of neurologic injury in patients presenting with chronic odontoid nonunion was 17.5%, similar to that of patients presenting with acute fracture > From: Kepler et al., Spine J 14 (2014) 903–908. All rights reserved to Elsevier Inc.

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