Controversies in the Management of Type II Odontoid Fractures.
| Autor: | Bhimani AD; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY., Harrop JS; Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA., Monnig E; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY., Elkersh Y; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY., Houten JK; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY. |
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| Jazyk: | angličtina |
| Zdroj: | Clinical spine surgery [Clin Spine Surg] 2024 Nov 01; Vol. 37 (9), pp. 372-378. Date of Electronic Publication: 2024 Oct 31. |
| DOI: | 10.1097/BSD.0000000000001702 |
| Abstrakt: | The management of type II odontoid fractures in the elderly is controversial, as these patients often have numerous medical comorbidities that increase the risks of surgery, but they may also fail to achieve fracture healing with nonsurgical management. Recent changes in technology and surgeon attitudes may influence the preferred approach to both surgical and nonsurgical treatments for many clinicians. While bony fracture healing remains the goal of management, a stable fibrous union is increasingly considered a satisfactory outcome. The optimal surgical approach remains debated, with some authors raising concerns about the risk of swallowing dysfunction being particularly problematic with odontoid screw placement in the elderly. The use of BMP-2 applied either anteriorly into the fracture site or posteriorly in the interlaminar space and placement of temporary posterior fixation to be removed upon demonstration of anterior bony healing are novel surgical techniques that are presently the subject of investigation. A clearer understanding of the currently available treatment options and the associated controversies may improve clinician decision-making and potentially better patient outcomes in the management of type II odontoid fractures for the growing geriatric population. Competing Interests: The authors declare no conflict of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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