Localizing the anatomy and variations of the vertebral artery will be vital for surgical planning. A CT angiogram allows the orthopedic surgeon to assess the location of vascular structures, including the vertebral artery. A CT scan helps the clinician better visualize the fracture and assess for any instability. Advanced imaging can include a computed axial tomography study (CT scan uses x-ray and computer technology), CT angiogram (CT scan using injection of contrast material), or magnetic resonance imaging (MRI test that shows bones, muscles, tendons, and ligaments). Additional radiographs may include cervical flexion (bending) and extension (straightening) views to assess for any instability. Physicians sometimes order a specific radiograph, known as the open-mouth odontoid view, to visualize the fracture. These x-rays include an anteroposterior (front to back) and lateral (side) view of the cervical spine. When there is suspicion of an odontoid fracture, the first screening involves a series of radiographs. Patients with neurological symptoms may complain of weakness in the hand and upper extremity and altered sensation. In rare instances, patients will have myelopathy (spinal cord injury) symptoms which may include abnormal reflexes, imbalance, and dexterity problems. Difficulty swallowing, also known as dysphasia, is another common finding and can be associated with bleeding from the fracture site leading to a hematoma (blood collection). Often, patients complain of neck pain and stiffness that is exacerbated during neck movement. Patients with odontoid fractures can present with a variety of symptoms. There are differing opinions on the clinical importance of these findings however, physicians believe they are due to an old trauma or from the odontoid not completely fusing during maturation. This condition is typically benign and management consists of continued observation. Type III fractures involve the lower portion of the C2 body at the C1 and C2 articulation.Īn associated condition in the same region is an Os odontoideum (the dens fails to fuse to the rest of C2 during development), that may be mistaken as a fracture of the odontoid. Additionally, Type II fractures are often the least stable of the odontoid fractures therefore physicians use further classification categories for Type II fractures (A, B, and C types). Type II fractures occur at the mid-portion (waist) of the odontoid and are known to have a high nonunion (a fracture that does not unite or heal) rate due to the watershed blood supply. Type I fractures are usually stable (does not move out of its normal position and alignment), causes pain, but does not create any neurologic problems, such as numbness in the back, legs, and arms. With a Type I fracture, the tip of the dens is broken. Physicians use a 3-type classification system to diagnose and treat odontoid fractures ( Fig. ![]() Together C1 and C2 create the joint for side-to-side and up-and-down movement of the head. The odontoid process is the pivot for the C1 vertebra, which carries the cranium (head). The dens is the size of your small finger tip, and it sticks up from the front of the C2 vertebra and fits into a groove in the C1 vertebra ( Fig. ![]() The joint between C1 and C2 is unique in that it allows more movement than the other spinal joints. The blood supply to C2 is from branches of the internal carotid artery (a main artery in your neck) and vertebral (spine) artery with limited blood supply in a portion of the odontoid, also known as a watershed area. At maturity, the C2 vertebra consists of the odontoid process and the body. The second cervical vertebrae, also known as C2 or the axis, in the spine develops from a fusion process by the age of 12. Overall, odontoid fractures are the most common fracture of the C2 vertebra and can account for up to 15% of all cervical spine (neck) fractures. ![]() Sometimes these fractures are missed or left untreated, and they can be associated with increased morbidity (disease) in older patients. These fractures can alter the biomechanics (movement) of the cervical spine leading to pain, neurologic problems (numbness in the back, legs, and arms), and decreased stability. In young people, the injury typically happens during a high-trauma event, such as a motor vehicle accident, but for older patients, it can occur during low-energy trauma, such as a fall. Odontoid fractures can happen at any age, but the injury occurs most often in adolescents or older patients. The odontoid process is a unique peg-like bony structure of the C2 (second cervical) vertebra in the neck that physicians sometimes refer to as the dens ( Fig.
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