The epidemiology of fractures and fracture-dislocations of the cervical spine

Ryan, Michael D.; Henderson, Jack

doi:10.1016/0020-1383(92)90123-a

Cited by 295 publications

(162 citation statements)

References 12 publications

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“…This distribution has been attributed to the tendency for the elderly to sustain simple falls, to have a greater risk of motor vehicle accidents, and to the biochemical attrition associated with senile osteopenia. Our study support previous studies, which reported that a simple fall was the most common mechanism of injury among the elderly, particularly females [10,11,13,18]. Patients sustaining low-energy falls (standing or seated heights) are more likely to injure their upper cervical spine in contrast to patients who are involved in high-energy injuries (falls from greater than standing height, motor vehicle accident [10].…”

Section: Discussionsupporting

confidence: 88%

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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: 88%

“…It is the most frequent individual fracture of the cervical spine in person aged 65 years and older [1, 7, 10-14, 16, 18]. Odontoid fracture also occurred most frequently in isolation [13]. In our study, among the C2 fractures (33.6%), odontoid fractures (83.3%) dominated the fracture pattern.…”

Section: Discussionsupporting

confidence: 49%

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

et al. 2008

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“…Fractures of the odontoid process have been reported with increasing frequency in recent years, and account for more than 10% of all cervical spine fractures, or the majority of upper cervical spine injuries in children and elderly patients [27]. Although different methods of treatment have been advocated, the outcomes are not as satisfactory as might be expected.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of nonunited fractures of the odontoid process, with special reference to occipitocervical fusion for unreducible atlantoaxial subluxation or instability

Dai

Yuan

et al. 2000

European Spine Journal

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“…We performed a systematic review of the literature on the outcome of patients undergoing surgery for Type II odontoid fractures. We assessed the outcomes of management of Type II odontoid fractures, the most commonly detected spinal fractures in patients 70 years of age or older, with evidence of increasing incidence in this population [34]. We also assessed the methodologic quality of the relevant clinical studies.…”

Section: Discussionmentioning

confidence: 99%

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

Denaro

Papalia

Martino

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Odontoid fractures are the most common odontoid injury and often cause atlantoaxial instability. Reports on postoperative status of patients who underwent surgery for such injuries are limited to small case series, and it is unclear whether any one technique produces better outcomes than another. Questions/purposes We assessed the quality of the available literature for management of Type II odontoid fractures and surgery-related parameters, including surgical indications, clinical failure rate, and survivorship, postoperative ROM and function, neurologic deficits, complication and death rates, and radiographic healing rates related to either anterior dens screw or posterior C1-C2 fusion.Methods We performed a systematic search in PubMed, Ovid, Cochrane Reviews, and Google Scholar databases. We used the methodology score proposed by Coleman et al. to rate study quality. Postoperative imaging bone union rates were extracted. Postoperative complications and neurologic impairment data were also collected. Results Sixteen retrospective studies of overall low quality (average methodology score, 37.1) reporting a total of 518 patients were included. The methodology score and publication year were positively associated. The bone union rate approximated 83% (range, 33%-100%), with higher nonunion rates among patients older than 65 years. The death rate ranged widely (0%-28.6%) among different centers. Residual cervical pain was documented postoperatively from 10.5% to 26.7%, while survivorship ranged from 72% to 96.6%. No ROM data were reported. Conclusions Current data on patients who had surgery for fracture of the dens did not allow us to establish superiority of one surgical approach over another.

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The epidemiology of fractures and fracture-dislocations of the cervical spine

Cited by 295 publications

References 12 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

Surgical treatment of nonunited fractures of the odontoid process, with special reference to occipitocervical fusion for unreducible atlantoaxial subluxation or instability

The Best Surgical Treatment for Type II Fractures of the Dens Is Still Controversial

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