Spinal stability restored: A case of odontoid fracture post-trauma

Ganesh Veerabhadraiah1, Sumana B Palleger2, Vivek Chandra3, Manjunath Reddy4, Yashoda5

1HOD-Neurosurgery, Kauvery Hospital, Electronic City, Bangalore

2Senoir Consultant-Neurosurgery, Kauvery Hospital, Electronic City, Bangalore

3Neuro – Anesthetist, Kauvery Hospital, Electronic City, Bangalore

4Senior Registrar, Neurosurgery, Kauvery Hospital, Electronic City, Bangalore

5Physician Assistant, Kauvery Hospital, Electronic City, Bangalore

Case Presentation

A middle-aged male, sustained a high-impact cervical spine injury following a road traffic accident (RTA) while riding a two-wheeler. He was hit by another two-wheeler, causing him to be thrown a significant distance. Post-accident, he experienced persistent neck pain but notably had no neurological deficits, indicating an isolated cervical spine injury without spinal cord compromise.

Investigations

To assess the extent of the injury, comprehensive imaging studies were performed:

  • CT Brain: Normal, ruling out intracranial injury.
  • CT Cervical Spine: Revealed a Type 3 odontoid fracture, characterized by a break at the base of the odontoid process and burst odontoid.
  • MRI Cervical Spine: Showed a normal spinal cord with no evidence of compression, confirming the fracture was mechanically unstable but not causing neurological damage.

Management

Given the diagnosis, the initial stabilization was achieved using a Philadelphia collar, ensuring immobilization of the cervical spine and pain control. However, due to the nature of the Type 3 odontoid fracture, which has a high risk of non-union with conservative treatment, surgical intervention was planned to provide definitive stability.

CV junction surgery is complex due to its proximity to the brainstem, cranial nerves, and vertebral arteries. It requires precise CT and MRI imaging to assess compression and instability.

Anatomical variations like basilar invagination and AAD complicate planning.

Surgical Approach

A posterior cervical fixation (C1-C2-C3) was performed to stabilize the fracture and prevent further displacement. The surgical technique included:

  • Right side: C1 and C3 lateral mass screws with a C2 translaminar screw for enhanced stability.
  • Left side: C1 and C3 lateral mass screws ensuring symmetrical fixation.
  • Postoperative imaging: X-rays confirmed correct implant placement and anatomical alignment.

Outcome and Recovery

  • Neck pain significantly reduced postoperatively.
  • The patient was mobilized the very next day, highlighting the benefits of early surgical stabilization.
  • He was discharged in stable condition on the second postoperative day with instructions for gradual return to daily activities.

Postoperative Imaging and Rehabilitation:

  • Post-op X-ray CV Junction: Showed stable fixation, confirming the success of surgical stabilization.
  • Clinical Recovery: The patient resumed walking without neurological deficits and showed steady improvement over follow-up visits.

Regarding surgery 

A Type 3 odontoid fracture is a break at the base of the odontoid process, extending into the body of the C2 vertebra. It is typically caused by high-impact trauma, such as road traffic accidents or falls, and is considered mechanically unstable due to its location. While some cases can heal with external immobilization (e.g., cervical collar or halo vest), surgical intervention is often preferred for better stability and faster recovery. The posterior cervical fixation (C1-C2-C3) technique is commonly used, involving lateral mass screws at C1 and C3, with additional C2 translaminar screws for reinforcement. This approach ensures rigid stabilization, promotes bony fusion, and allows early mobilization, reducing complications like non-union or delayed healing.

Key Takeaways

This case underscores the importance of timely diagnosis and surgical intervention in managing cervical spine fractures. The combination of early surgical stabilization and mobilization played a crucial role in ensuring a faster recovery and reducing complications like non-union or chronic pain. His successful outcome highlights the role of multidisciplinary care, including neurosurgery, radiology, and rehabilitation, in managing complex cervical spine injuries.

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