Simon Diaz,Mejdeddine Al Barajraji,Victoria Deambour,Dominique Rothenfluh,Juan Barges-Coll
{"title":"Assessing the impact of undiagnosed C1-C2 rotatory subluxation in the conservative treatment of Odontoid fractures.","authors":"Simon Diaz,Mejdeddine Al Barajraji,Victoria Deambour,Dominique Rothenfluh,Juan Barges-Coll","doi":"10.1016/j.wneu.2024.09.035","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nThe presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation-Grades 1, 2, or 3-can often be overlooked, and as a result, prognostic associations with C2 fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent C1‒C2 rotatory subluxation.\r\n\r\nMETHODS\r\nRetrospective, cohort (nested case‒control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1-C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio (OR) and generate a ROC curve of the association between the degree of subluxation and failure of conservative treatment.\r\n\r\nRESULTS\r\n115 patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 , 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation ,(odds ratio 10), compared with patients without C1-C2 subluxation.\r\n\r\nCONCLUSIONS\r\nIn our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions.","PeriodicalId":23906,"journal":{"name":"World neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.9000,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"World neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.wneu.2024.09.035","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BACKGROUND
The presence of clear high-grade rotatory subluxation, in addition to an odontoid fracture, is a definite indication for surgery. However, the presence of a more subtle subluxation-Grades 1, 2, or 3-can often be overlooked, and as a result, prognostic associations with C2 fractures are rare. In light of this, we assessed the failure rate of conservative management in patients with both an odontoid fracture and a concurrent C1‒C2 rotatory subluxation.
METHODS
Retrospective, cohort (nested case‒control) study of patients with odontoid C2 fractures with or without C1‒C2 joint rotatory subluxation was performed. Patients were classified according to the type of odontoid fracture (Alonzo classification) and the presence of C1-C2 subluxation (Feldings classification). The number of patients who were initially treated with collars and then underwent surgery due to conservative treatment failure was analyzed. We performed logistic regression analysis to determine the odds ratio (OR) and generate a ROC curve of the association between the degree of subluxation and failure of conservative treatment.
RESULTS
115 patients with C2 fractures that were treated conservatively with or without C1‒C2 rotatory subluxation. Of all 115 , 29 (25%) experienced treatment failure and required surgery. A statistically significant correlation was found between treatment failure and the presence of rotatory subluxation ,(odds ratio 10), compared with patients without C1-C2 subluxation.
CONCLUSIONS
In our series, C2 Alonzo fractures with a C1‒C2 rotatory subluxation had a 10-fold increased risk of secondary displacement and subsequent need for surgery. Further research on this association could improve the management of these conditions.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS