22318 Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting

Name of the Procedure:

Open Treatment and/or Reduction of Odontoid Fracture(s) and/or Dislocation(s) (including Os Odontoideum), Anterior Approach, Including Placement of Internal Fixation; Without Grafting

Summary

In layman's terms, this procedure involves surgically fixing fractures or dislocations of the odontoid process—the bony projection at the top of the spine near the neck—through the front (anterior) of the neck. Metal screws or plates are used to hold the bones in place, but no additional bone grafts are used.

Purpose

This procedure addresses fractures or dislocations of the odontoid process to stabilize the spine, reduce pain, and restore normal neck movement. It aims to prevent potential spinal cord injury and improve the overall alignment of the cervical spine.

Indications

• Severe neck pain and instability due to a fractured or dislocated odontoid process
• Spinal cord compression symptoms like numbness or weakness in the limbs
• Traumatic neck injuries involving the odontoid process
• Diagnosed instability in the cervical spine due to congenital conditions like os odontoideum

Preparation

• Patients may be advised to fast for 8-12 hours before the procedure.
• Certain medications, especially blood thinners, might need to be paused.
• Preoperative imaging tests such as X-rays, CT scans, or MRIs are performed to assess the condition.
• A thorough medical evaluation to ensure the patient’s readiness for surgery.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia to ensure they remain asleep and pain-free.
2. Incision: A small incision is made on the front (anterior) of the neck.
3. Exposure: The surgeon carefully navigates through tissues to expose the fractured or dislocated odontoid process.
4. Reduction: The bone fragments are realigned to their normal anatomical position.
5. Internal Fixation: Screws or plates are placed to stabilize the fracture or dislocation.
6. Closure: The incision is closed with sutures, and a sterile dressing is applied.

Duration

The procedure typically takes 2-4 hours, depending on the complexity of the condition.

Setting

The surgery is performed in a hospital operating room.

Personnel

• Orthopedic or neurosurgeon specializing in spine surgery
• Anesthesiologist
• Surgical nurses and assistants
• Radiologic technologists (intraoperative imaging support)

Risks and Complications

• Infection at the surgical site
• Bleeding or hematoma formation
• Injury to surrounding structures such as blood vessels or nerves
• Failure of the fixation devices (screws or plates)
• Adverse reactions to anesthesia
• Scar formation and potential need for additional surgery

Benefits

• Stabilization of the cervical spine
• Significant reduction in pain
• Prevention of further spinal cord damage
• Improved neck function and mobility

Recovery

• Hospital stay of 1-2 days post-surgery for monitoring
• Pain management with prescribed medications
• Wearing a cervical collar or brace for several weeks
• Gradual return to normal activities over 4-6 weeks
• Follow-up appointments for X-rays to monitor the healing process

Alternatives

• Non-surgical treatment with neck braces or collars (may be less effective in severe cases)
• Posterior surgical approach with potential use of bone grafting (varies in technique and recovery)
• Physical therapy as conservative management for mild forms

Patient Experience

During the procedure, the patient will not feel anything due to general anesthesia. Post-surgery, they might experience neck pain and discomfort, which can be managed with medications. Patients are typically advised to avoid heavy lifting and strenuous activities during the initial healing period, and they may need assistance with some daily activities. Regular follow-up visits ensure proper recovery and adjustment of the treatment plan.