Surgical versus conservative management for odontoid fractures

Shears E, Armitstead CP

Summary

Surgical versus conservative management for an odontoid fracture (a serious neck injury)

The seven bones making up the neck region of the backbone are called the cervical vertebrae. The first vertebra, called the atlas, supports the skull. Underneath this is the axis or second vertebra, which has a upward pointing process called the odontoid process around which the atlas can rotate, enabling the head to be turned. Fracture of the odontoid process is a serious injury and is often fatal. In survivors there is a risk of ongoing damage to the spinal cord and paralysis. People with these fractures are often treated conservatively, which entails stabilisation of the neck in devices such as a 'Halo' (external frame) and/or rigid collar for several months. Another option is surgical stabilisation of the fractured parts. The review aimed to examine the evidence from randomised controlled trials comparing surgical versus conservative treatment for these fractures to find if either approach gave a better outcome. Despite a comprehensive search, the review authors found no evidence from randomised controlled trials to inform the choice between surgical and conservative management.