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10214697 tn?1408624045

Remote 9 mm Type 2 Dens Fracture

I fractured my dens about 5 years ago. I have been living with the pain ever since. The doctor said I have a muscle union, but not a bony union. I am pretty sure at my last MRI/CT Scan a couple years ago, the specialist said I have a 9mm type 2 dens fracture and I will need surgery. They recommend a spinal fusion, but I would lose 50% of my neck movement. Please see attached picture.

I absolutely don't want to lose any neck movement, but from doing my research it looks like this is the only method where I would achieve a bony union. I have seen that surgeons can perform an anterior screw fixation, but the chances of a union are very low since it's an old fracture. I also saw that they can perform this procedure with an injection of recombinant human bone morphogenic protein (rhBMP-2) (Medtronic Inc.).

I have been able to manage the pain by taking Cymbalta, but it gives me ridiculous anxiety/depression so I had to stop. I have two questions. 1) What pain meds can I take to control the pain in the meantime? Anyone recommend Lyrica or Savella? 2) Are there any other procedures to achieve bony union without losing 50% of my neck movement? I am getting to the point where I can't live with this pain anymore, but I am risking 50% of my neck movement, more pain, and future spine problems from the fusion.
10 Responses
620923 tn?1452915648

  Hi and welcome to the Spinal Cord C/D forum.

Not being a medical professional it is hard to answer your questions....

I know a bony fusion will limit ROM but as to how much ...I can not say....from seeing others have screws implanted only to loosen and need more surgery to recover the  screws, I myself would not want to go that route.

I was told I need a fusion for different reasons as yours...and I have put it off and will continue to unless I develop pains or issues that demand it be done,...

None of the pain meds mentioned have been used by myself....keep in mind we are all different as to which med will work best for us, so only trial and error can we find which one works best.

My mom on the other hand was given the Savella for fibro and was not happy with the side effects....

All you can do is try them and report any and ALL side effects ASAP to your Dr.
7721494 tn?1431627964
Odontoid fractures are severe upper c. spine injuries that can cause pain and paralysis. The fact that you've lived for 5 years like this amazes me. You must be stable. Do you wear a hard collar?

As you probably know, since your fracture is so large chances for healing and improvement decrease with age. The problem is blood supply. These fractures limit blood supply to the bone, slowing or preventing healing.

I'm not sure why you are hearing fusion causes 50% loss in ROM.How many opinions have you had? Henry reported  in 1999 that 92% achieved bony union at an average of 14.1 weeks after anterior fusion/fixation. Two patients required a secondary posterior fusion after failure of the index operation. A full range of movement was restored in 43 patients; only six had a limitation of movement greater than 25% (http://www.ncbi.nlm.nih.gov/pubmed/10872369)

Has no one offered to treat your pain with opioid analgesics?

If Cymbalta is causing problems, then expect similar side effects with Savella. Lyrica may help, as may Neurontin. Neither of these medications are SNRIs, like Cymbalta and Savella.

Get other opinions on Tx with anterior screw fixation.

Fusion may indeed cause domino effect by requiring additional fusions below C2 with time, but if instability is threatening patency of intrathecal space at C2 or causing severe spinal stenosis, you must consider surgery to protect the cord.
10214697 tn?1408624045
I have had 2 opinions in the past 5 years saying I need a posterior fusion. And from all the research I have done, any posterior surgery will result in 50% loss in ROM. Anterior fixation requires certain ligament/body displacement and has a low fusion rate for injuries over 6 months. Meaning I can take the chance with an anterior fixation surgery if I meet the requirements, but I have maybe a 30% fusion rate. And if the bone doesn't fuse, then I have to get another surgery for a posterior fusion.

There are some days where I feel good and the pain is minimal. But most days I have chronic pain, especially under my right shoulder blade. If you take a look at my profile picture, the fracture is clearly visible with bone missing.

In the end, unless the advancement of technology results in alternative ways to create a bony fusion for the dens, I am looking at a posterior fusion. And my only issue is that the pain I am in now, could be even worse from surgery with a 50% loss in ROM.
7721494 tn?1431627964
Two opinions seems inadequate.

You have to consider the estimates of success only that -- estimates. Longitudinal studies on success rates of various surgical procedures are the best estimates, but you are not a sample, you are an individual and your results will be successful or not accordingly. What I'm saying is that statistics do not apply to an individual, but only a sample group.

The problem with fusing at a high level in the spine is that the inferior discs take on the work and load of the superior bones, causing them to wear and dessicate at an accelerated rate. You end up with a domino effect, having to fuse C3-C4, then C4-5-6, etc. Soon enough after fusion, you'll have no range of motion.

But, you have an odontoid fracture, which must be treated. The instability is dangerous. What if you're in an accident and experience whiplash? What if you fall? You're pushing the odds.

One thing surgeons take into account is the age of the patient. Are you young or old. If you're young, they figure that you'll heal quickly, and if it doesn't work the first time, they'll try again. If you're old, they figure that well, he doesn't need as much range of motion.

See a few more neck surgeons and get their opinions about using the front or back door.

Best wishes.
10214697 tn?1408624045
Currenly 25 years old. Live in PA and looking for the best spine surgeons. Any recommendations on how to find the best surgeons?
7721494 tn?1431627964
Sometimes asking your doc "if you were to have this surgery, who would you choose" gets you a thoughtful answer. Word of mouth is your best bet.

I wish we had a directory showing specialists by area, by surgeries performed per consult, but outcomes -- but we do not yet have this resource.

Some people are using Angie's list. Check it out.
620923 tn?1452915648

  What part of PA?..I am also in PA...Eastern part...hour and a half north west of Philly....

Finding Drs is not easy....we started a Drs list in a different forum to help others with the same condition....but the list is not a referral nor a endorsement for those on it, it is only meant to be used as a tool for researching Drs...a starting point....maybe we can start one here...let us know if you find a Dr and how  you like the care you get and we could start one here too.
10214697 tn?1408624045
Southern PA by Maryland line.
John Hopkins Hospital-Baltimore, MD is rated #3 in neurosurgery.
Hospital for Special Surgery-New York, NY is rated #1 in orthopedics.
I am probably going to get an opinion at both hospitals.
620923 tn?1452915648

  Thanks for letting me know....BTW- when I needed surgery for a brain issue I went to NY as well....different condition and issue then you have...but found the best there,
7721494 tn?1431627964
Probably a good idea. Very tricky surgery in a sensitive location.

best of luck
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