Vertical fracture of the odontoid process: case report

Fifteen percent of cervical spine fractures involve the odontoid process. Most odontoid fractures can be classified as Types I through III according to the scheme developed by Anderson and D'Alonzo. We report a case of a vertically oriented fracture through the odontoid process that does not fit into any of these categories. Only two such cases have been described in the literature. Our patient is an 18-year-old man who sustained an axial loading injury to his cervical spine. Plain lateral cervical tomography and computed tomography were performed to characterize the fracture and to evaluate the instability. The patient was placed in a rigid orthosis for 12 weeks, and at 6-month follow-up, he had full range of motion and showed no evidence of abnormal movement, as revealed by flexion-extension studies. This case demonstrates the shortcomings of the current classification system for odontoid fractures and value of plain tomography and computed tomography in evaluating odontoid fractures.