Axis fractures: conservative or surgical approach? A systematical literature review

OBJECTIVES. More than 60% of spinal injuries affect the cervical spine, and axis fractures account for 20% acute cervical spine injuries. An odontoid fracture along its base represents the most frequent injury to the axis. Both conservative management, using external orthosis or external fixator, and surgical fixation through posterior or anterior approach, may result axis fractures. The purpose of this article was to review the literature on axis fractures attempting to offer recomandations for management, using evidence-based criteria. METHODS. This review utilized a MEDLINE search of the medical literature from 1966 to 1999. Collected data regarded 778 cases of fracture of the odontoid process and 503 cases of Hangman's fracture. RESULTS. All data resulted from Class III studies. No statistical difference was noted between conservative or surgical management for type I and II odontoid fractures, and for Hangman's fractures. Surgery resulted more effective for type II odontoid fractures. Both posterior and anterior approach resulted effective. CONCLUSIONS. Although pooling of data set render estimate more accurate and generalizable, it must be taken into consideration that our observations were based entirely on the review on Class III data that are inadequate to establish either treatment standard or guidelines. Tehrefore, all management modalities described remain treatment options.