Presentation
Neck pain post fall from chair, twice
Patient Data
Acute minimally displaced transverse fracture through the base of the odontoid process of C2 with 1-2 mm retrolisthesis of the odontoid fragment. No extension of the fracture into the lateral masses. No widening of the predental space or central canal stenosis.
Case Discussion
In younger patients, odontoid fractures usually result from high-energy trauma, such as motor vehicle or diving accidents. In the elderly, the fracture can occur from lower energy impacts, such as falling from own height.
Fractures of C2 are the most common cervical spine injuries in the elderly, and most frequently are of the odontoid process.
A widely used classification for odontoid fractures is Anderson and D'Alonzo classification, which classifies them based on their location, extension and stability. A fracture occurring across the base of the odontoid process, near its junction with the C2 vertebral body is in keeping with a type II odontoid fracture. Posterior displacement of the C1 arch and odontoid relative to the C2 body may be associated. Type II fractures are the type most likely to progress to non-union and surgical fusion may be required to achieve stability.
Case co-author: Rehana Jaffer, MD, FRCPC
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