Patients over 60 years of age with a dens fracture had a higher complication rate and lower cervical range of motion when treated conservatively with a halo. Final functional outcome and overall pain levels, however, did not differ significantly by age group or treatment modality.
Fourteen-millimeter lateral mass screws (effective length, 11 mm) placed in a superolateral trajectory in the adult cervical spine provide an equivalent strength with a much lower risk of injury than the longer bicortical screws placed in a similar orientation.
The results of nonoperative treatment of low lumbar burst fractures were comparable with those of operative treatment. The rate of repeat surgery (41%) and absence of a clearly definable long-term functional or radiographic benefit in patients without neurologic compromise may make surgery less appealing.
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