Functional Outcomes, Morbidity, Mortality, and Fracture Healing in 58 Consecutive Patients with Geriatric Odontoid Fracture Treated with Cervical Collar or Posterior Fusion

Molinari, William J.; Molinari, Robert W.; Khera, Oner A.; Gruhn, William

doi:10.1055/s-0033-1337122

Cited by 50 publications

(16 citation statements)

References 29 publications

(54 reference statements)

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“…Molinari et al . also demonstrated a higher complication rate in the operative group (24% versus 6%) . This was confirmed in the current study, with a significantly higher rate of pneumonia, respiratory failure, cardiac arrhythmia and deep vein thrombosis in the operative group ( P < 0.05).…”

Section: Discussionsupporting

confidence: 87%

Morbidity and mortality in cervical spine injuries in the elderly

Bokhari

Sivakumar

Sefton

et al. 2018

ANZ Journal of Surgery

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Background: The aim of our study was to identify the demographics and complications in elderly cervical spine injuries and predictive factors for surgery, complications and mortality. We hypothesized younger healthier patients were more likely to undergo surgical intervention. Methods: A retrospective review of 225 consecutive patients aged 65 years and over with cervical spine injuries was carried out over a 3-year period. Results: There were 113 males and 112 females with an average of 79.7 years (range 65-98). The most common fracture was C2 peg type (21.8%). Five patients had complete spinal cord injury (2.2%), 25 had incomplete spinal cord injury (11.1%) and 84% were neurologically intact. Fifty-four patients were managed operatively (24%), while 171 patients were managed non-operatively (76%). The operative group had higher rates of pneumonia (odds ratio (OR) 5.3, 95% confidence interval (CI) 2.6-10.7, P < 0.01), cardiac arrhythmia (OR 4.1, 95% CI 1.5-11.2, P < 0.01) and respiratory failure (OR 2.6, 95% CI 1.2-5.5, P < 0.05). There was no difference in mortality between the operative and non-operative group (18.5% and 12.9%, P = 0.3). Patients with complete spinal cord injury had 100% mortality. Significant predictive factors for complications and death were neurological deficits, comorbidities and the presence of other injuries (P < 0.05). Surgery was not predictive for death and the operative group was younger than the non-operative group (P < 0.05). Conclusions: In the setting of a high complication rate, consideration should be given to palliation in elderly patients with complete spinal cord injury and there must be good rational for surgery.

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Section: Discussionsupporting

confidence: 87%

Morbidity and mortality in cervical spine injuries in the elderly

Bokhari

Sivakumar

Sefton

et al. 2018

ANZ Journal of Surgery

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“… 2 , 9 , 11 Outcomes from this injury have shown to have high rates of morbidity and mortality and a poor prognosis regardless of the treatment. 12 , 15 – 24 Studies have described operative fixation of GOFs and have shown high rates of morbidity and mortality. 18 , 21 , 25 , 26 A less invasive treatment with a halo vest has been described with varying success.…”

Section: Discussionmentioning

confidence: 99%

“… 12 , 15 – 24 Studies have described operative fixation of GOFs and have shown high rates of morbidity and mortality. 18 , 21 , 25 , 26 A less invasive treatment with a halo vest has been described with varying success. 11 , 27 – 32 However, due to significant respiratory complications and increased morbidity, halo vests are not recommended in the elderly patients.…”

Section: Discussionmentioning

confidence: 99%

Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion

Raudenbush

Molinari

2015

Geriatr Orthop Surg Rehabil

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Introduction:Longer-term outcomes of patients with geriatric type II odontoid fracture nonunion remain unclear.Methods:Thirty-four consecutive geriatric patients (>70 years old) with minimally displaced (<50% displacement) type II odontoid fractures were treated 24 hours a day for 12 weeks with rigid collar immobilization between the years 2003 and 2011. Radiographic and medical record reviews were performed on all 34 patients. Additionally, 7 patients were available for clinical longer-term follow-up (>4 years).Results:In all, 30 (88%) of the 34 patients had nonunion after 12 weeks of treatment, 2 (6%) patients had union, and 2 (6%) patients died during the first 12 weeks. Twenty-one of the 30 patients with nonunion had a displaced or mobile nonunion (70%), and 4 (12%) patients were lost to follow-up. At longer-term follow-up, 23 (68%) patients had died. The average time death occurred was 3.8 years with a range of 0.17 years to 9.42 years postinjury. Twenty of the 23 deaths were attributed to medical comorbidities not related to the patient’s odontoid nonunion. We were unable to determine the cause of death in 3 patients. None of the patients who died had identifiable clinical myelopathy prior to their death on chart review. Of the 7 patients who were alive, all were determined to have odontoid nonunion, of which 5 (70%) were mobile odontoid nonunion. Visual Analog Scale (VAS) and Neck Disability Index (NDI) scores were low (VAS averaged 0.57 and NDI averaged 6.9%) and treatment satisfaction was high (averaged 9.7 of 10). Scores for pain and function did not differ significantly when compared to age-matched controls (P = .08, t test).Conclusion:Rates of odontoid nonunion are high in patients with geriatric odontoid fractures that are treated with continuous rigid collar for 12 weeks. The majority of patients with nonunion appear to achieve high functional outcomes. In this study, mortality did not appear to be related to adverse neurologic events after treatment.

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“…This matches with our results, as we did not find any difference related to sex, but the fusion was faster with younger patients in comparison to older ones. Additionally, Molinari et al 20 found poor results in geriatric patients even with rigid posterior fixation. All our cases were posttraumatic, so surgeries were done shortly after trauma.…”

Section: Journalmentioning

confidence: 99%

Posterior C1-2 Temporary Fixation without Fusion for Recent Odontoid Fractures

Samy

Elbanna

Sorour

2019

Egyptian Spine Journal

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Background Data: Posterior C1-C2 fusion techniques are the commonly used treatment for odontoid fracture. This procedure is usually associated with limitation in the cervical spine range of motion (ROM) especially the rotational motion. Posterior C1-C2 temporary fixation technique can spare the range of motion of the atlantoaxial joint after odontoid fracture healing is complete. Purpose: To assess the clinical and radiological outcome of the posterior C1-C2 temporary fixation technique in the treatment of a new odontoid fracture. Study Design: It is a retrospective study with clinical and radiological evaluation before and after instrumentation removal. Patients and Methods: Twelve consecutive patients, suffering from type-II odontoid fracture, were retrospectively recruited for this study. The age ranged between 15 and 43 years with a mean age being 24±11.6 years. Eight patients were males and four were females. All cases suffered from acute posttraumatic type-II dens fracture. Eight patients suffered from reducible subluxation and four cases were in place. Only two patients were suffering from partial neurologic deficit preoperatively (grade 4). All patients were submitted to Harms' atlantoaxial fixation procedure. Surgical removal of the implants was done after a mean of 15.5 (range, 12-20 weeks) weeks from the first surgery. All patients had MSCT scan to assess healing and then dynamic MSCT scan after removal to assess C1-C2 ROM. Results: All of our twelve patients completed the two procedures without significant events. Two patients with preoperative neurological illness had improved gradually with physiotherapy. All patients had complete healing of their factures. Postoperative dynamic CT scan showed partial restoration of the rotation after removal of instrumentations with a mean total rotation restoration of 30±8°. Significantly better functional outcomes were observed after the temporary fixation removal using Visual Analog Scale (VAS) score for neck pain (P=0.0033), neck stiffness, and the patient satisfaction. Conclusion: Posterior atlantoaxial temporary fixation is a good salvage approach in dealing with odontoid fracture, especially when anterior odontoid screw is contraindicated. By regaining partial ROM, the functional outcome of the patients improved. (2019ESJ187)

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Functional Outcomes, Morbidity, Mortality, and Fracture Healing in 58 Consecutive Patients with Geriatric Odontoid Fracture Treated with Cervical Collar or Posterior Fusion

Cited by 50 publications

References 29 publications

Morbidity and mortality in cervical spine injuries in the elderly

Morbidity and mortality in cervical spine injuries in the elderly

Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion

Posterior C1-2 Temporary Fixation without Fusion for Recent Odontoid Fractures

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