Published online Jan 18, 2017. doi: 10.5312/wjo.v8.i1.82
Peer-review started: April 1, 2016
First decision: May 17, 2016
Revised: June 15, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: January 18, 2017
Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type II fractures are the most common fracture pattern in elderly patients. Treatment (rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type II odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid non-union successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.
Core tip: Odontoid fractures are common in elderly patients and treatment of these injuries remains challenging. Conservative management consists of rigid immobilization with collar or Halo vest. Delayed union or non-union is a common outcome in patients treated conservatively. For a symptomatic non-union, surgery may be the only option. In this case report we discuss the case of a patient with an odontoid fracture non-union successfully treated with systemic anabolic Teriparatide therapy. A complete fusion was achieved after 12 wk of treatment. Teriparatide therapy may have a role in fostering fusion of C2 fractures in elderly patients.