Posterior Temporary Fixation Versus Nonoperative Treatment for Anderson-D'Alonzo Type III Odontoid Fractures: Functional Computed Tomography Evaluation of C1-C2 Rotation.

Abstract

To evaluate differences in radiologic and functional outcomes between C1-C2 posterior temporary fixation (PTF) and cephalocervicothoracic cast fixation for type III odontoid fractures. Data from 13 patients who underwent PTF and 13 cases who underwent cephalocervicothoracic cast fixation due to fresh type III odontoid fractures were reviewed retrospectively. All patients with fracture healing underwent a functional computed tomography scan at the final follow-up to evaluate the range of motion in C1-C2 rotation. Functional outcomes were evaluated in the form of visual analog scale for neck pain, neck stiffness, patient satisfaction, and Neck Disability Index. The outcomes were compared between the 2 groups. At the final follow up, all 26 patients achieved healing of their fractures. There were no complications associated with either treatment. The left-to-right ranges of motion of C1-C2 rotation were 41.9° ± 11.9° in the PTF group and 43.5° ± 12.0° in the cephalocervicothoracic cast fixation group. There was no statistical difference between the 2 groups regarding the C1-C2 rotation angle (P > 0.05). There also were no significant differences between 2 groups in functional outcomes evaluated by visual analog scale for neck pain, neck stiffness, Neck Disability Index, and patient satisfaction (all P > 0.05). The outcomes of PTF and cephalocervicothoracic cast fixation were comparable in the treatment of type III odontoid fractures. For type III odontoid fractures that cannot be managed by nonoperative fixation or anterior screw fixation, PTF may be the treatment of choice, because it spares the motion of the C1-C2 complex.