Combined Fractures of the Odontoid Process and Upper Thoracic Spine: A Case Report

Combined Fractures of the Odontoid Process and Upper Thoracic Spine: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Combined Fractures of the Odontoid Process and Upper Thoracic Spine: A Case Report hasan ali aydın This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6104908/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : This report presents a rare case of combined odontoid process and upper thoracic spine fractures, which are infrequently reported in the literature. Case : A 39-year-old male sustained a 4-meter fall, resulting in a posteriorly displaced type II odontoid fracture and a T5 burst fracture with rotation. Remarkably, no neurological deficit was observed. Methods : Anterior screw fixation stabilized the odontoid, while posterior fusion (T1-T7) addressed the thoracic injury. Results : Imaging suggested cervical hyperextension and thoracic flexion-rotation mechanisms. Stabilization was successful, with no postoperative neurological impairment. Conclusion : Combined fractures of the odontoid process and upper thoracic spine are rare, high-energy injuries with significant neurological risk. This case highlights effective management of a rare injury pattern and suggests limited canal compromise may preserve neurological function, offering insights for multilevel spinal trauma care. Neurosurgery Odontoid fracture thoracic spine combined injury surgical fixation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Introduction Multiple-level spinal fractures are well-documented in high-energy trauma, such as motor vehicle accidents or falls, with upper thoracic second-level injuries reported in up to 17% of cases.^1^ However, combined fractures of the odontoid process and upper thoracic spine are exceedingly rare. These injuries often involve complex biomechanics—cervical hyperextension and thoracic flexion-rotation—and are associated with high neurological risk due to the narrow upper thoracic spinal canal.^2^ This report describes a rare case of combined odontoid and T5 fractures following a fall, managed surgically without neurological sequelae, and discusses the injury mechanism and outcomes. Case Report A 39-year-old male fell 4 meters from a roof on June 3, 2013. He presented alert (Glasgow Coma Scale: 15/15), with no neurological deficits. Cervical radiographs revealed a posteriorly displaced type II odontoid fracture (Anderson and D'Alonzo classification ^4^; Figure 1), confirmed by CT (Figure 2). Thoracic imaging showed a T5 burst fracture with rotation and canal invasion (Figures 3, 4). Surgical stabilization occurred one-day post-injury: anterior screw fixation for the odontoid (Figure 5) and posterior T1-T7 fusion with polyaxial screws (Figure 6). Postoperative imaging confirmed stability, with no deficits. Discussion Combined odontoid and upper thoracic fractures are rare, reflecting distinct biomechanical forces. The odontoid fracture suggests hyperextension, while the T5 injury indicates flexion-rotation forces.^1^ Upper thoracic fractures require significant energy due to chest wall stability. These injuries involve flexion, axial compression, rotation, and shear, often resulting in paralysis (up to 85%) due to the narrow canal. ^2,3^ Remarkably, this patient had no neurological deficit despite a canal-intruding T5 fragment. This may stem from a dominant axial force with minimal shear, reducing cord injury.^5^Biomechanical studies indicate that burst fractures in non-osteoporotic spines produce significant canal intrusion, increasing neurological risk. In contrast, osteoporotic or degenerate spines with reduced bone mass may yield less invasive fractures, as in vertebra plana, with lower neurological sequelae. Though not osteoporotic, this patient's less invasive T5 burst pattern may explain the outcome, consistent with disc degeneration studies. ^6^ Conclusion Surgical management—anterior odontoid fixation and posterior thoracic fusion—achieved stability without complications, demonstrating efficacy in this rare presentation. Declarations The patient and his/her relatives were provided with the necessary and detailed explanation and information about the use of hospital records related to the current case, and approval was obtained for use in any academic study and article. Informed Consent: Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the consent form is available upon request. Ethical Statement: This report adheres to the ethical principles of the Declaration of Helsinki. As a retrospective case report involving standard clinical care, formal ethical approval was not required by our institution. Patient anonymity has been preserved. References Rogers LF, et al. Am J Roentgenol. 1980;134:67-73. Bohlman HH, et al. J Bone Joint Surg Am. 1985;67:360-9. Daffner RH, et al. Skeletal Radiol. 1987;16:280-4. Anderson LD, et al. J Bone Joint Surg Am. 1974;56:1663-74. Shirado O, et al. Spine. 1992;17:286-92. Murai H, et al. Osteoporos Jpn. 1995;3:167-9. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6104908","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":420698122,"identity":"6887b4b1-a3b3-4bbe-9dca-7f9385010f3e","order_by":0,"name":"hasan ali 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increased kyphosis.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6104908/v1/6b8f52a3cd5c6b54dd34447e.png"},{"id":78326913,"identity":"ec3b5500-50c7-4f3b-b27e-066fc149e2af","added_by":"auto","created_at":"2025-03-12 06:36:35","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":216596,"visible":true,"origin":"","legend":"\u003cp\u003eSagittal and axial thoracic CT: T5 burst fracture with canal intrusion.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6104908/v1/dac888e7e46360721594b0dc.png"},{"id":78326658,"identity":"3d6491f4-7adf-455a-8962-f6b74ae24885","added_by":"auto","created_at":"2025-03-12 06:28:36","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":197480,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative sagittal and axial cervical CT: anterior screw fixation of the odontoid.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6104908/v1/abb433305ec397b68fa5aaec.png"},{"id":78326911,"identity":"0b94d093-7b4b-483b-a694-c9df0ce787ea","added_by":"auto","created_at":"2025-03-12 06:36:34","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":483752,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative sagittal, coronal and axial thoracic CT: posterior T1-T7 stabilization.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6104908/v1/1635a985586c67a1bdf5d7a8.png"},{"id":78328140,"identity":"20a3a98f-578a-47cc-a8c3-a33ce2c646a5","added_by":"auto","created_at":"2025-03-12 06:44:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2024509,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6104908/v1/a6c7d565-62c1-4d61-844a-84b4b0135aa8.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eCombined Fractures of the Odontoid Process and Upper Thoracic Spine: A Case Report\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMultiple-level spinal fractures are well-documented in high-energy trauma, such as motor vehicle accidents or falls, with upper thoracic second-level injuries reported in up to 17% of cases.^1^ However, combined fractures of the odontoid process and upper thoracic spine are exceedingly rare. These injuries often involve complex biomechanics\u0026mdash;cervical hyperextension and thoracic flexion-rotation\u0026mdash;and are associated with high neurological risk due to the narrow upper thoracic spinal canal.^2^ This report describes a rare case of combined odontoid and T5 fractures following a fall, managed surgically without neurological sequelae, and discusses the injury mechanism and outcomes.\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 39-year-old male fell 4 meters from a roof on June 3, 2013. He presented alert (Glasgow Coma Scale: 15/15), with no neurological deficits. Cervical radiographs revealed a posteriorly displaced type II odontoid fracture (Anderson and D\u0026apos;Alonzo classification ^4^; Figure 1), confirmed by CT (Figure 2). Thoracic imaging showed a T5 burst fracture with rotation and canal invasion (Figures 3, 4). Surgical stabilization occurred one-day post-injury: anterior screw fixation for the odontoid (Figure 5) and posterior T1-T7 fusion with polyaxial screws (Figure 6). Postoperative imaging confirmed stability, with no deficits.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCombined odontoid and upper thoracic fractures are rare, reflecting distinct biomechanical forces. The odontoid fracture suggests hyperextension, while the T5 injury indicates flexion-rotation forces.^1^ Upper thoracic fractures require significant energy due to chest wall stability. These injuries involve flexion, axial compression, rotation, and shear, often resulting in paralysis (up to 85%) due to the narrow canal. ^2,3^ Remarkably, this patient had no neurological deficit despite a canal-intruding T5 fragment. This may stem from a dominant axial force with minimal shear, reducing cord injury.^5^Biomechanical studies indicate that burst fractures in non-osteoporotic spines produce significant canal intrusion, increasing neurological risk. In contrast, osteoporotic or degenerate spines with reduced bone mass may yield less invasive fractures, as in vertebra plana, with lower neurological sequelae. Though not osteoporotic, this patient's less invasive T5 burst pattern may explain the outcome, consistent with disc degeneration studies. ^6^\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eSurgical management\u0026mdash;anterior odontoid fixation and posterior thoracic fusion\u0026mdash;achieved stability without complications, demonstrating efficacy in this rare presentation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cspan\u003eThe patient and his/her relatives were provided with the necessary and detailed explanation and information about the use of hospital records related to the current case, and approval was obtained for use in any academic study and article.\u003c/span\u003e\u003c/p\u003e\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eInformed Consent:\u003c/strong\u003e Written informed consent was obtained from the patient for the publication of this case report and accompanying images. A copy of the consent form is available upon request.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eEthical Statement:\u003c/strong\u003e This report adheres to the ethical principles of the Declaration of Helsinki. As a retrospective case report involving standard clinical care, formal ethical approval was not required by our institution. Patient anonymity has been preserved.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRogers LF, et al. Am J Roentgenol. 1980;134:67-73.\u003c/li\u003e\n\u003cli\u003eBohlman HH, et al. J Bone Joint Surg Am. 1985;67:360-9.\u003c/li\u003e\n\u003cli\u003eDaffner RH, et al. Skeletal Radiol. 1987;16:280-4.\u003c/li\u003e\n\u003cli\u003eAnderson LD, et al. J Bone Joint Surg Am. 1974;56:1663-74.\u003c/li\u003e\n\u003cli\u003eShirado O, et al. Spine. 1992;17:286-92.\u003c/li\u003e\n\u003cli\u003eMurai H, et al. Osteoporos Jpn. 1995;3:167-9.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"zonguldak bülent ecevit üniversitesi","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Odontoid fracture, thoracic spine, combined injury, surgical fixation","lastPublishedDoi":"10.21203/rs.3.rs-6104908/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6104908/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: This report presents a rare case of combined odontoid process and upper thoracic spine fractures, which are infrequently reported in the literature.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e: A 39-year-old male sustained a 4-meter fall, resulting in a posteriorly displaced type II odontoid fracture and a T5 burst fracture with rotation. Remarkably, no neurological deficit was observed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Anterior screw fixation stabilized the odontoid, while posterior fusion (T1-T7) addressed the thoracic injury.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: Imaging suggested cervical hyperextension and thoracic flexion-rotation mechanisms. Stabilization was successful, with no postoperative neurological impairment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: Combined fractures of the odontoid process and upper thoracic spine are rare, high-energy injuries with significant neurological risk. This case highlights effective management of a rare injury pattern and suggests limited canal compromise may preserve neurological function, offering insights for multilevel spinal trauma care.\u003c/p\u003e","manuscriptTitle":"Combined Fractures of the Odontoid Process and Upper Thoracic Spine: A Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-12 06:20:30","doi":"10.21203/rs.3.rs-6104908/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"54272fcc-0e3c-4123-b421-2672d4eb8241","owner":[],"postedDate":"March 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44845573,"name":"Neurosurgery"}],"tags":[],"updatedAt":"2025-03-12T06:20:30+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-12 06:20:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6104908","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6104908","identity":"rs-6104908","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}