Subaxial Cervical Spine Injury in the Elderly and Treatment-Related Mortality – Anterior or Posterior Approach

Abstract

Background Subaxial cervical spine injury especially in the elderly can be associated to severe complications and disability. Until today there is no consensus concerning the best operative treatment. A potential superiority of anterior or posterior fixation is the subject of controversial discussions. Objectives The aim of this study was to compare the outcome of anterior and posterior fixation after subaxial cervical spine trauma in the elderly focussing on the postoperative mortality. Material and Methods A retrospective cohort analysis was performed to analyse the data of 43 patients. Especially mortality data were collected. Results A total of 43 patients was identified. Anterior fixation was performed in 21 patients, posterior fixation was performed in 22 patients. There were no significant differences between these groups. Although statistical significance was not reached, a slightly higher mortality was found among patients undergoing anterior fixation (52,4 vs. 31,8%). Furthermore the male sex, a higher age, translation injuries, long duration of operation and hospitalisation as well as postoperative complications were slightly associated to a higher mortality. Conclusions Subaxial cervical spine trauma is associated to a high mortality in the elderly. Although neither anterior nor posterior fixation could show a significant superiority, every surgical decision making should be performed individually for each patient balancing the advantages and disadvantages of each method.

Combined Odontoid (C2) and Atlas (C1) Fractures in Geriatric Patients: A Systematic Review and Treatment Recommendation

“…21 Generally, there are recommendations preferring an initially posterior approach in patients or injuries with a high biomechanical instability, thus as geriatric patients with a stiffening disease (M. Bechterew or Forestier) or with highly unstable translational injuries. 22 As long as closed reduction is feasible, posterior stabilization as described by Magerl 23 or an anterior approach is possible. The Magerl technique is a less-invasive procedure to treat atlanto-axial traumatic instability, particularly when performed in a percutaneous way.…”

“…Generally, there are recommendations preferring an initially posterior approach in patients or injuries with a high biomechanical instability, thus as geriatric patients with a stiffening disease (M. Bechterew or Forestier) or with highly unstable translational injuries. 22…”

Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries – a Survey-based Analysis at German Spine Care Centres

“…Stabilisation through internal fixation procedures has been described mainly via the anterior and posterior approaches, which can be used individually or in combination 1 , 2 , 3 . The decision regarding the type of surgical intervention depends primarily on the injury morphology 4 , 5 , 6 , clinical experience 4 , 5 , 6 , and findings of biomechanical experiments 7 , 8 , 9 , 10 , 11 , 12 , but available data on post-operative treatment are insufficient.…”

“…Prinzipiell sind interne Stabilisierungsverfahren von ventral sowie von dorsal beschrieben, die einzeln oder in Kombination ein- oder zweizeitig, erfolgen können 1 , 2 , 3 . Während die Wahl der operativen Therapie in erster Linie von der Verletzungsmorphologie abhängt und sich auf klinische 4 , 5 , 6 und biomechanisch-experimentelle 7 , 8 , 9 , 10 , 11 , 12 Erkenntnisse stützt, ist die Datengrundlage zur Nachbehandlung postoperativ unzureichend.…”