Management of odontoid fractures in the elderly

Abstract

Odontoid fractures are frequent in patients over 70 years of age, and in patients over 80 years of age they form the majority of spinal fractures. In a retrospective analysis of 23 geriatric (> 70 years) patients with a fracture of the odontoid, we compared some of the clinical features to a contemporary series of patients younger than 70 years of age. Whereas in the younger patients high-energy trauma accounted for the majority of the fractures, low-energy falls were the underlying cause in 90% of the odontoid fractures in the elderly. In contrast to the younger age group, in elderly patients predominantly type II fractures (95%) were identified. Anterior and posterior displacement were recorded with equal frequency on the first postinjury radiograph in the younger age group, whereas in geriatric patients displacement was mainly posterior. The number of associated injuries was significantly higher in younger patients. There was no difference in the occurrence of neurological deficits (13%) between the two age groups, and neurological compromise was mainly related to posterior dislocation of the odontoid in both groups. The overall complication rate was significantly higher in elderly patients (52.2% vs 32.7%), with an associated in-hospital mortality of 34.8%. Loss of reduction and non-union after non-operative treatment, a complicated postoperative course and complications due to associated injuries accounted primarily for this high complication rate. Elderly patients with a fracture of the odontoid are a high-risk group with a high morbidity and mortality rate. An aggressive diagnostic approach to detect unstable fractures and application of a halo device or early primary internal stabilisation of these fractures is recommended.

CT evaluation of the pattern of odontoid fractures in the elderly?relationship to upper cervical spine osteoarthritis

“…Type II fracture at the junction of dens and body of the axis accounts for 95% of odontoid process fractures in the elderly [8], as compared with 60% in the general population [3]. The population of the mobile elderly is rising steadily, and ,hence, the number of low-energy traumatic events resulting from accidental falls is increasing.…”

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IntroductionAbove the age of 70 years, fracture of the odontoid process is the most common cervical spine injury [8,9]. Unlike the younger population, in whom odontoid process fractures are caused by high-energy injuries, in the elderly population they are frequently caused by low-energy trauma like falls [8,10].

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“…Unlike the younger population, in whom odontoid process fractures are caused by high-energy injuries, in the elderly population they are frequently caused by low-energy trauma like falls [8,10]. The classification system detailed by Anderson and D' Alonzo for odontoid process fractures is Abstract Odontoid fractures are common in the elderly following minor falls.…”

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

“…Recently, usage of the semi-rigid cervical collar was shown to confer a comparable capacity in limiting motion at C1-2 if compared to the HTV [12]. In view of distinct surgical and medical aspects, literature serves sufficient evidence that surgical treatment of displaced OF is beneficial [3,39,40,45,52,53]. The current rigid techniques for the treatment of OF include an instrumented posterior fusion of C1-2 or AOSF.…”

“…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.…”