Age increases the risk of immediate postoperative dysphagia and pneumonia after odontoid screw fixation

Vasudevan, Kavita; Grossberg, Jonathan A; Spader, Heather S.; Torabi, Rana; Oyelese, Adetokunbo A.

doi:10.1016/j.clineuro.2014.09.006

Cited by 25 publications

(15 citation statements)

References 30 publications

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“…Similar complications after AOSF in older patients regarding dysphagia problems were reported by Vasudevan et al 38 These authors evaluated immediate complications after AOSF, such as postoperative dysphagia and pneumonia, in 30 patients with Type II odontoid fractures. Complications included pneumonia in 9 patients (30%), gastrostomy tube placement due to swallowing problems in 13 patients (43%), and vocal cord paralysis in 1 patient (3.3%).…”

Section: Use Of 1 or 2 Screwsmentioning

confidence: 49%

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

Joaquim

Patel

2015

FOC

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Odontoid fractures comprise as many as 20% of all cervical spine fractures. Fractures at the dens base, classified by the Anderson and D’Alonzo system as Type II injuries, are the most common pattern of all odontoid fractures and are also the most common cervical injuries in patients older than 70 years of age. Surgical treatment is recommended for patients older than 50 years with Type II odontoid fractures, as well as in patients at a high risk for nonunion. Anterior odontoid screw fixation (AOSF) and posterior cervical instrumented fusion (PCIF) are both well-accepted techniques for surgical treatment but with unique indications and contraindications as well as varied reported outcomes. In this paper, the authors review the literature about specific patients and fracture characteristics that may guide treatment toward one technique over the other. AOSF can preserve atlantoaxial motion, but requires a reduced odontoid, an intact transverse ligament, and a favorable fracture line to achieve adequate fracture compression. Additionally, older patients may have a higher rate of pseudarthrosis using this technique, as well as postoperative dysphagia. PCIF has a higher rate of fusion and is indicated in patients with severe atlantoaxial misalignment and with poor bone quality. PCIF allows direct open reduction of displaced fragments and can reduce any atlantoaxial subluxation. It is also used as a salvage procedure after failed AOSF. However, this technique results in loss of atlantoaxial motion, requires prone positioning, and demands a longer operative duration than AOSF, factors that can be a challenge in patients with severe medical conditions. Although both anterior and posterior approaches are acceptable, many clinical and radiological factors should be taken into account when choosing the best surgical approach. Surgeons must be prepared to perform both procedures to adequately treat these injuries.

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Section: Use Of 1 or 2 Screwsmentioning

confidence: 49%

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

Joaquim

Patel

2015

FOC

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“…Among the etiological factors, first (59.4%) fall from high and second (40.6%) traffic accidents have been observed (Table 1). there is no gender difference in the prevalence of odontoid fractures seen in old age [9]. The most common cause of odontoid fracture is trauma [10].…”

Section: Resultsmentioning

confidence: 98%

Type II odontoid fractures: Complication, mortality, and outcome after posterior C1-C2 fixation and fusion, single institute experience

Gezgin¹,

Gokten

Sezer

et al. 2020

Preprint

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Background The aim of the present study was to evaluate long term C1-C2 fusion rates and functional outcomes in patients with type II odontoid fractures treated with posterior fixation with polyaxial C1 lateral mass and C2 pars screws. Methods A total of 32 patients were retrospectively evaluated. Study parameters included Japanese Orthopaedic Association (JOA) score and visual analog scale score for neck pain. All patients had computerized tomography (CT) scans preoperatively and at six months postoperatively; X-rays preoperatively and at three months and 12 months after operation Results Among the etiological factors, first (59.4%) fall from high and second (40.6%) traffic accidents have been observed. The duration of follow-up was 28.4 ± 8.5 months. A total of 25 patients had improvement on mean VAS score. A total of 12 patients had improvement at modified JOA score. No vascular injury occurred in our series. One patient (3.1%) developed hospital pneumonia, and the patient died at postoperative 6 th week. One patient (3.1%) had nonunion, but no neurological deficit was observed, and revision surgery was not needed 30 patients (93.8%) had fracture healing and fusion after posterior C1-C2 fixation. Conclusions In our opinion, posterior C1-C2 fixation and fusion is the treatment of choice in type II odontoid fractures with good fusion results. We achieved good results and low complication and mortality rates.

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“…The decision for a posterolateral approach was made due to the high rates of dysphagia in the elderly after high anterior cervical procedures. 3,5,12,23 The patient was placed in a neutral position and, after opening and releasing the posterior cervical paraspinal musculature, the head holder was readjusted to restore cervical lordosis; however, there was no significant change in the patient's spinal alignment. As a result, it was decided that the patient's neutral position was chronic; given that the primary goal of the procedure was not to adjust her global alignment, as this was not an issue for her prior to the fracture, the neutral cervical position was left unchanged.…”

Section: Operationmentioning

confidence: 99%

C-2 arteriovenous fistula presenting as a pathologic hangman's fracture: case report

Sen¹,

Benjamin²,

Riina³

et al. 2017

SPI

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The authors report on an 81-year-old woman with a pathologic hangman's fracture secondary to a complex arteriovenous fistula (AVF). The patient presented with severe, unremitting neck pain and was found to have fractures bilaterally through the pars interarticularis of C-2 with significant anterior subluxation of C-2 over C-3 along with widening of the left transverse foramen. Due to an abnormally appearing left vertebral artery (VA) on CT angiography, the patient underwent conventional angiography, which revealed a complex AVF stemming from the left VA at the level of C-2 with dilated posterior cervical veins and a large venous varix. Given the radiographic evidence of bone remodeling and the chronicity of the AVF, it is believed that the C-2 vertebra was weakened over time by the pulsatile and compressive force of the vascular malformation eventually leading to fracture with minimal stress. Coil embolization of the AVF was performed followed by surgical fixation of C-1 to C-4. This case highlights the importance of investigating an underlying disease process in patients who present with significant spinal fractures in the absence of trauma.

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Age increases the risk of immediate postoperative dysphagia and pneumonia after odontoid screw fixation

Cited by 25 publications

References 30 publications

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

Type II odontoid fractures: Complication, mortality, and outcome after posterior C1-C2 fixation and fusion, single institute experience

C-2 arteriovenous fistula presenting as a pathologic hangman's fracture: case report

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