Odontoid Fractures: Current Evaluation and Treatment Principles

Fractures of the odontoid process of the second cervical vertebra represent one of the most common and controversial injury types affecting the cervical spine. These fractures are observed in nearly all age groups but the incidence peaks in young adults and the elderly. The rate of associated spinal cord injury is considered relatively low but is not insignificant at approximately 20% of cases. Achieving osseous healing and long-term stability are principal concerns, although fibrous nonunion may provide adequate stability in certain patient populations such as low-demand elderly patients. Following careful scrutiny of radiological studies and thoughtful consideration of clinical factors, various treatment plans often remain viable options for any given patient. While nonsurgical management is always appealing when appropriate, early surgery frequently provides an ideal opportunity to achieve stable fracture healing without functional compromise. In most cases, early surgery also restores sufficient immediate stability to allow rapid patient mobilization without the need for external orthoses or halo vest immobilization, thereby reducing the risk of medical complications related to prolonged recumbency.