Management of Type II Odontoid Process Fractures in Geriatric Patients; A Prospective Study of Sequential Cohorts with Attention to Survivorship

Bednar, Drew A.; Parikh, Jay R.; Hummel, Jonathan

doi:10.1097/00002517-199504000-00013

Cited by 119 publications

(65 citation statements)

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“…The remaining 16.6% were of other patterns (hangman-3, body fractures-2, lamina fracture-1). These results correlate with those of some studies [3,14], although another had identified fractures of the atlanto-axial complex in all patients [18]. In addition to the tendency of cervical fractures in the elderly to involve the atlanto-axial complex, there is also a tendency towards combination C1-C2 fractures, represented by 5.6% of fractures in our study.…”

Section: Discussionsupporting

confidence: 92%

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

et al. 2008

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We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66-93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1-9 years) and mean in-hospital stay was 10 days (2-90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit at time of injury. Outcome of the injury was related to increasing age, co-morbidity and the severity of neurological deficit. Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilization or surgical stabilization.

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Section: Discussionsupporting

confidence: 92%

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

et al. 2008

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“…In contrast to similar injuries in younger patients, dens fractures in the elderly are typically sustained by low-energy mechanisms [2][3][4][5] . Like younger patients, elderly individuals with a dens fracture Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work.…”

mentioning

confidence: 99%

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Vaccaro¹,

Kepler²,

Kopjar³

et al. 2013

The Journal of Bone and Joint Surgery

121

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“…In contrast to previous studies dealing with this clinically relevant topic [1,6,9,10,15,31,64], all patients included in this study were subject to not only pre-but also postoperative CT-scans, providing valuable data regarding fracture properties and factors influencing osseous union rates. Our findings confirmed that AOSF in the recent reducible OF represents a safe alternative to posterior fusion in the appropriately selected elderly patient and fracture.…”

Section: Resultsmentioning

confidence: 99%

“…Odontoid fractures (OF) are the most common cervical spine fracture in patients aged older than 70 years and even the most common spinal fracture of patients aged older than 80 years [1][2][3][4][5]. Treatment of OF yields for stable osseous fusion to avoid the risk of late neurologic deterioration due to instability at C1-C2.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

et al. 2011

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In the elderly population, reported union rates with anterior odontoid screw fixation (AOSF) for odontoid fracture (OF) treatment vary between 23 and 93% when using plain radiographs. However, recent research revealed poor interobserver reliability for fusion assessment using plain radiographs compared to CT scans. Therefore, union rates in patients aged C60 years treated with AOSF have to be revisited using CT scans and factors for non-union to be analysed. Prospectively gathered consecutively treated patients using AOSF for odontoid fracture with age C60 years were reviewed. Medical charts were assessed for demographics, clinical outcomes and complications. Patients' preoperative radiographs and CT scans were analysed to characterize fracture morphology and type, fracture displacement, presence of atlanto-dental osteoarthritis as well as a detailed morphometric assessment of fracture surfaces (in mm 2 ). CT scans performed after a minimum of 3 months postoperatively were analysed for fracture union. Those patients not showing CT-based evidence of completely fused odontoid fracture were invited for radiographic follow-up at a minimum of 6 months follow-up. Follow-up CT-scan were studied for odontoid union as well as the number of screws used and the square surface of screws used for AOSF and the related corticocancellous osseous healing surface of the odontoid fragment (in %) were calculated. Patients were stratified whether they achieved osseous union or fibrous non-union. Patients with a non-union were subjected to flexionextension lateral radiographs and the non-union defined as stable if no motion was detected. The sample included 13 male (72%) and 5 female (18%) patients. The interval from injury to AOSF was 4.1 ± 5.3 days (0-16 days). Age at injury was 78.1 ± 7.6 years (60-87 years) and follow-up was 75.7 ± 50.8 months (4.2-150.2 months). 10 patients had dislocated fractures, 14 had Type II and 4 ''shallow'' Type III fractures according to the Anderson classification, 2 had stable C1-ring fractures, 8 had displayed atlantodental osteoarthritis. Fracture square surface was 127.1 ± 50.9 mm 2 (56.3-215.9 mm 2 ) and osseous healing surface was 84.0 ± 6.8% (67.6-91.1%). CT-based analysis revealed osseous union in 9 (50%) and non-union in 9 patients (50%). Union rates correlated with increased fracture surface (P = 0.02). Statistical analysis revealed a trend that the usage of two screws with AOSF correlates with increased fusion rates (P = 0.06). Stability at C1-2 was achieved in 89% of patients. CT scans are accepted as the standard of reference to assess osseous union. The current study offers an objective insight into the union rates of odontoid fractures treated with AOSF using CT scans in consecutive series of 18 patients C60 years. Literature serves evidence that elderly patients with unstable OF benefit from early surgical stabilization. However, although using AOSF for unstable OF yields segmental stability at C1-2 in a high number of patients as echoed in

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Management of Type II Odontoid Process Fractures in Geriatric Patients; A Prospective Study of Sequential Cohorts with Attention to Survivorship

Cited by 119 publications

References 0 publications

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

Functional and Quality-of-Life Outcomes in Geriatric Patients with Type-II Dens Fracture

Efficacy of anterior odontoid screw fixation in the elderly patient: a CT-based biometrical analysis of odontoid fractures

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