Main treatments for type II fracture of the axis tooth

Abstract

Introduction:
Axis tooth fractures are frequent injuries of the cervical spine. There is a growing prevalence of high-energy trauma and falls from standing heights, especially in patients over 65 years of age, in whom mortality is higher. Type II, considered the most frequent and unstable, consists of a fracture of the neck of the axis tooth and can cause cervical medullary compression. Objective: To know the main treatments for type II fracture of the axis tooth. Methods: From April to May 2022, in PubMed/Medline and in the Virtual Health Library, the combination of descriptors ‘’Odontoid Processes’’ AND (‘’treatment’’ OR “therapeutics”) AND “spinal fractures” were investigated. Results: From the bibliographical analysis of the nine articles, surgical treatments and conservative treatments were found for the type II fracture of the axis tooth. cervical traction can be performed to realign the spine and increase the chances of bone fusion. For external immobilization, the Halo brace is indicated, although it does not promote bone union. As an alternative treatment, the rigid cervical collar provides stabilization of the cervical spine, but it also does not result in bone union. In the surgical field, the most recurrent treatment is anterior fixation of the screw, which aims to provide bone union. When the latter is not feasible, posterior fixation of the screw is chosen, which guarantees stable bony fusion by inserting a temporary screw. In cases of dorsal displacement of the spine, occipitocervical fusion is performed. Conclusion: The main surgical treatments for type II fracture of the axis tooth are anterior or posterior screw fixation, occipitocervical fusion and transoral odontoidectomy. As for conservative treatments, stabilization equipment is discussed, such as the rigid cervical collar and the Halo vest to perform external immobilization and cervical traction.