![]() Sometimes, the weak or brittle bone fractures when the surgeon tries to place screws to fix the fracture. The surgeon may have a hard time finding solid enough bone to insert screws to help stabilize the spine. Bone loss in older adults makes surgery very difficult. But some experts think that the respiratory compromise and the other symptoms may really be as a result of inactivity and poor follow-up care.Īnd the potential complications with surgery are much more serious than with nonoperative care. Difficulty breathing leading to respiratory problems has been reported. Infection can occur at the pin sites for the halo brace. Pressure ulcers (skin sores) develop with either form of immobilization. The reason for this may be because the collars limit, but don't prevent, neck motion.Ĭomplications can occur with either choice (cervical collar or halo vest). Sometimes there is a loss of reduction (the bones slip or displace). For example, cervical collars don't always hold the fracture site until healing occurs. These conclusions support the results of other studies that show some disadvantages in using cervical collars alone for Type II odontoid fractures. Mild-to-moderate disability was reported in 24 or the 32 patients. Function was good-to-excellent in almost all of the patients in this group. But the fracture union rate was lower in this group (37.5 per cent) compared to the patients treated with the cervical collars (50 per cent). In the halothoracic group, stability of the fracture site was achieved in all 32 patients. Ratings from the Neck Disability Index and Smiley-Webster Scale for this group showed mild disability in eight of the patients. Fibrous union means the fracture filled in with strong enough scar tissue (but not bone cells) to prevent movement at the fracture site. Cervical spine stability was achieved either by bone fusion or by fibrous union. Nine of the 10 patients treated with a rigid cervical collar had good results. Two specific tests of long-term function were used: the Neck Disability Index and the Smiley-Webster Scale. Function included neck range-of-motion and ability to perform daily activities. Pain and function were two other outcome measures used to compare patient results with conservative care. X-rays were taken to see if bone fusion had taken place. Sometimes the halo brace is referred to as a halo vest.īracing was used for 12 to 24 weeks. This vest offers the weight to anchor the ring and immobilize the neck. Four metal bars attach the halo ring to a vest worn on the chest. This portion of the brace is secured to the skull by metal screws (pins). The halo brace is a titanium ring (the halo) that goes around the head. Results were compared for 10 patients who used the cervical collar and 32 patients who were placed in a halothoracic brace. The two most common forms of immobilizers used in this study included a rigid cervical collar and a halothoracic brace. If the atlas and axis have not been displaced (moved), then immobilizing the neck for a period of time is an option. Surgery is indicated in cases of nonunion instability such as recurrent dislocation or when there is serious neurologic involvement (e.g., paralysis). If conservative care fails, then surgery to fuse the spine can be done. In fact, this approach is preferred because of known complications that occur when surgery is done for this problem in older adults. Nonoperative treatment to allow the bone to knit back together can be successful. Type II odontoid fractures are unstable because they can be displaced so easily. The spinal canal is a round opening or hollow tube formed by the vertebrae stacked on top of each other. This puts a tremendous compressive or stretching force on the spinal cord as it goes down through the spinal canal. Without this piece of bone in place, the first two vertebral bones (the atlas and the axis) can slide apart. The joints of the axis give the neck most of its ability to turn to the left and right.Ī Type II odontoid fracture occurs right where the odontoid process attaches to the C2 vertebral body. The dens points up and fits through a hole in the first cervical vertebra (called the atlas). The odontoid process is also called the dens. The odontoid is a bony knob or upward projection of bone on top of the second cervical vertebra (C2). This type of fracture is most common in older adults who fall and break off the odontoid in the cervical spine (neck). Everyone in the study was at least 65 years old. Researchers from Australia present the positive results of 42 patients with a Type II odontoid (neck) fracture who were treated conservatively (without surgery). Physical Therapy in California South Bay for Upper Back and Neck
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