Management of upper cervical spine fractures in elderly patients: current trends and outcomes

Delcourt, Tiphanie; Bégué, Thierry; Saintyves, Guillaume; Mebtouche, Nasser; Cottin, P.

doi:10.1016/s0020-1383(15)70007-0

Cited by 66 publications

(72 citation statements)

References 27 publications

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“…In our cohort, patients who were treated non-operatively had a shorter hospital stay but were more likely to die during the hospitalization. Hence, as in other studies, the impact of a surgical intervention on the occurrence of complications was minor, as most part inhospital complications were determined by the prevalence of preexisting comorbidities [13,19].…”

Section: Discussionmentioning

confidence: 69%

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Epidemiology and management of atlas fractures

et al. 2020

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Purpose The purpose of this study was to gain new insights into the epidemiologic characteristics of patients with atlas fractures and to retrospectively evaluate complication rates after surgical and non-surgical treatment. Methods In a retrospective study, consecutive patients diagnosed with a fracture of the atlas between 01/2008 and 07/2018 were analyzed. Data on epidemiology, concomitant injuries, fracture patterns and complications were obtained by chart and imaging review. Results In total, 189 patients (mean age 72 years, SD 19; 57.1% male) were treated. The most frequent trauma mechanism was a low-energy trauma (59.8%). A concomitant injury of the cervical spine was found in 59.8%, a combined C1/C2 injury in 56.6% and a concomitant fracture of the thoraco-lumbar spine in 15.4%. When classified according to Gehweiler, there were: 23.3% type 1, 22.2% type 2, 32.8% type 3, 19.0% type 4 and 1.1% type 5. Treatment of isolated atlas fractures (n = 67) consisted of non-operative management in 67.1%, halo fixation in 6.0% and open surgical treatment in 26.9%. In patients with combined injuries, the therapy was essentially dictated by the concomitant subaxial cervical injuries. Conclusions Atlas fractures occurred mainly in elderly people and in the majority of the cases were associated with other injuries of the head and spine. Most atlas fractures were treated conservatively. However, surgical treatment has become a safe and valid option in unstable fracture patterns involving the anterior and posterior arch (type 3) or those involving the articular surfaces (type 4).1. Atlas fractures occurred mainly in elderly people and in the majority of the cases were associated with other injuries of the head and spine. 2.A concomitant injury of the cervical spine was found in 59.8 %, a combined C1/C2 injury in 56.6 %.3. Most atlas fractures were treated conservatively. However, surgical treatment has become a safe and valid option in unstable fracture patterns involving the anterior and posterior arch (type 3) or those involving the articular surfaces (type 4).Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionmentioning

confidence: 69%

“…When classified by Gehweiler, 23.3% represented type 1 fractures, 22.2% type 2 fractures, 32.8% type 3 fractures, 19.0% type 4 fractures and 1.1% type 5 fractures ( Fig. 3).…”

Section: Resultsmentioning

confidence: 99%

Epidemiology and management of atlas fractures

et al. 2020

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“…Previous studies have summarized the controversy regarding surgical versus nonsurgical management of Type II odontoid fractures. 3,4,7,11,15,18,22 However, there exists no consensus regarding to the best management of this fracture type. In our patient cohort we found that all fracture patterns were treated predominately with nonoperative management.…”

Section: Discussionmentioning

confidence: 99%

Patterns of C-2 fracture in the elderly: comparison of etiology, treatment, and mortality among specific fracture types

Radovanovic

Urquhart

Rasoulinejad

et al. 2017

Journal of Neurosurgery: Spine

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OBJECTIVEPrevious studies have focused on Type II odontoid fractures and have failed to report on the effect of other C-2 fracture types on treatment and outcome. The purpose of this study was to compare patient characteristics, cause of injury, predisposing factors to fracture, treatments, and mortality rates among C-2 fracture types in a cohort of elderly patients 70 years of age and older.METHODSA retrospective cohort study design was used. Patients who sustained a C-2 fracture between 2002 and 2011 and who were admitted to the authors’ Level 1 trauma center were identified using the Discharge Abstract Database and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) code S12.1. Fractures were classified as odontoid Type I, II, or III; hangman’s; C-2 complex (hangman’s appearance on sagittal images, Type III odontoid on coronal cuts); and other (miscellaneous). Age, sex, predisposing factors to falls, cause of injury, treatment, presence of autofusion in the subaxial cervical spine, and mortality rates were compared between fracture patterns.RESULTSOne hundred forty-one patients were included; their mean age was 82 years. Fractures included Type II odontoid (57%), complex (19%), Type III odontoid (11%), hangman’s (8%), and other (5%). Falls from a standing height accounted for 47% of injuries, and 65% of patients had ≥ 3 risk factors for falls. Subaxial autofusion was more common in odontoid fractures (p = 0.002). Treatment was mainly nonoperative (p < 0.0001). The 1-year mortality rate was 27%. Four patients died of spinal cord injury.CONCLUSIONSAlthough not as common as Type II odontoid fractures, other C-2 fractures including hangman’s, complex, and Type III odontoid fractures accounted for close to half of the injuries in the study cohort. There were few differences between the fracture types with respect to cause of injury, predisposing factors, or mortality rate. However, surgical treatment was more common for Type II odontoid fractures.

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“…Bei Polytraumata, ausgeprägten Disklokationen mit hoher resultierender Instabilität oder Fehlstellung und/oder vorliegenden neurologischen Beeinträchtigungen wird eine initiale Operation häufig favorisiert [8,11].…”

Section: Einführungunclassified

“…Warum ist die geriatrische Fraktur des Dens axis Typ II nach Anderson und D'Alonzo eine Problemfraktur? ▪ Das Vorliegen der im Alter häufigen Osteopenie/Osteoporose führt zu einer hohen Pseudarthroserate, die mit steigendem Alter zunimmt [1,8,12]. ▪ Unabhängig von einer etwaigen Osteoporose zeigen ältere…”

Section: Einführungunclassified

Geriatrische Dens-Fraktur – Konservative Therapie

Heyde

2018

Die Wirbelsäule

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ZusammenfassungDie Therapie geriatrischer Densfrakturen, insbesondere des Typ II nach Anderson und D’Alonzo, wird nach wie vor kontrovers diskutiert. Aktuelle Reviews und erste prospektive Studiendaten legen Vorteile der operativen Versorgung, vor allem in Bezug auf die Mortalitätsrate, nahe.Eine kritische Würdigung der zur Verfügung stehenden Daten der aktuellen Literatur führt jedoch zu Ergebnissen, welche eine vorsichtige Interpretation dieser Daten nahelegen und einen weiterhin hohen Stellenwert der konservativen Therapie aufzeigen.Die Komplikationsrate beider Vorgehensweisen – operativ versus konservativ – ist vergleichbar. Die konservative Therapie ist mit einer höheren Pseudarthroserate verbunden. Allerdings wird das Erreichen einer fibrösen Steife auch als Therapieerfolg angesehen und der klinische Stellenwert der Pseudarthrose verbleibt unklar. Die Datenlage in Bezug auf die Mortalität ist nach wie vor, auch in Reviews und Metaanalysen, inkonsistent. Während bei Patienten zwischen 65 bis 80 – 85 Jahre die Mortalität nach konservativer Versorgung höher zu sein scheint, gibt es Arbeiten, die bei Patienten ab 80 – 85 Jahren eine Aufhebung dieser Unterschiede und in dieser Altersklasse generell Vorteile der konservativen Therapie sehen.Das zentrale Problem der aktuell zur Verfügung stehenden Literatur, auch der vorliegenden prospektiven aber nicht randomisierten Daten besteht in dem Selektionsbias und damit in der fehlenden wirklichen Vergleichbarkeit der analysierten Patientenkohorten.Somit konnte bis zum jetzigen Zeitpunkt keine wirkliche Überlegenheit einer der beiden Therapieformen aufgezeigt werden. Damit hat die konservative Therapie ihren Stellenwert und muss in die therapeutischen Überlegungen gleichberechtigt einbezogen werden.

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Management of upper cervical spine fractures in elderly patients: current trends and outcomes

Cited by 66 publications

References 27 publications

Epidemiology and management of atlas fractures

Epidemiology and management of atlas fractures

Patterns of C-2 fracture in the elderly: comparison of etiology, treatment, and mortality among specific fracture types

Geriatrische Dens-Fraktur – Konservative Therapie

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