13, 14 There is an increasing role for MR imaging, with its superior soft-tissue resolution, in the acute setting in patients with neurologic injury not only to evaluate the spinal cord but also to define areas of ligamentous injury that may relate to clinical instability. 12Ĭurrently, cervical spine trauma is most commonly evaluated with multidetector CT with sagittal and coronal reconstructions, which have improved delineation of fractures compared with plain radiographs. 10, 11 Because fracture acuity is a critical factor in healing, both for nonoperative and surgical interventions, it is important to identify the odontoid fracture when advising patients on treatment recommendations. 4, 7 ⇓– 9 While operative intervention may result in high rates of fracture healing, surgery may involve excess morbidity and mortality in elderly patients. 5, 6 However, specific factors that have been shown to contribute to nonunion with orthosis alone include advanced patient age, increased degree and angulation of odontoid displacement (4–6 mm and >10° angulation), and delayed treatment. Some series have reported successful fracture healing with external mobilization alone in 37%–75% of patients. Treatment of type II odontoid fractures remains controversial. 1 ⇓– 3 Prompt and accurate diagnosis of these fractures is critical in patient management because they are associated with a high rate of nonunion in some patient populations, particularly if acuity is unrecognized. ![]() Spine fractures in older patients following ground-level falls are common, with type II odontoid fractures occurring most frequently. As such, in this patient population, in which the presence of bone marrow edema as an indicator of fracture acuity may impact therapeutic decisions, correlation with CT findings and clinical history is crucial. Additionally, interobserver agreement in STIR interpretation decreases with increasing patient age. ![]() CONCLUSIONS: Older patients, particularly those with osteopenia, may have acute odontoid injuries without corresponding STIR hyperintensity.
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