Vertical Fracture of the Odontoid Process

Fractures of the odontoid process of the axis usually occur transversely at the neck or base of the odontoid, are often displaced, and frequently require surgical fixation. Sagittal or coronal fractures are uncommon and can best be visualized on coronal or sagittal reconstruction of CT scans. Routine radiographs may not allow precise diagnosis. Vertical fractures, either sagittal or coronal, generally do not require operative treatment. This report describes an unusual fracture of the odontoid process sustained by a 56-year-old male after falling down a flight of stairs. He was neurologically intact, and the fracture healed with immobilization in a rigid cervical brace. Only 11 other case reports have been identified in a literature review. Both coronal and sagittal reconstructions should be obtained in suspected cases of odontoid fracture. Without instability on flexion/extension views or ligamentous injury on an MRI scan, a rigid brace or halo vest can be used to promote healing of the fracture, which may occur in 12 weeks.