Odontoid Fractures in the Elderly: Dorsal C1/C2 Fusion is Superior to Halo-Vest Immobilization

Frangen, T.M.; Zilkens, Christoph; Muhr, G.; Schinkel, Christian

doi:10.1097/ta.0b013e318060d2b9

Cited by 99 publications

(81 citation statements)

References 29 publications

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“…Although some authors advocate external immobilisation as the treatment of choice for type II OF in an elderly population [7,11,20], high fusion rate and best clinical outcome are obtained by surgical treatment [5,8,13,14,[17][18][19]. Bone fusion rate in our series (44%) was lower than bone fusion rate described in the literature [17,19] which ranged from 80 to 100%.…”

Section: Discussioncontrasting

confidence: 58%

“…In this study, the morbidity rate was 62% without distinction between surgical procedures. The other studies did not distinguish octogenarians from other elderly patients [3,5,7,8,11,13,15,18,24,25]. We specifically studied type IIB OF because among all types of OF they are considered as the most unstable.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, conservative treatment could lead to the development of delayed myelopathy in patients with non-union of the OF [4]. Posterior fusion of the C1/C2 complex is superior to external immobilisation in terms of radiological outcome and morbidity and mortality [2,8] and produces the highest fusion rates among the different types of surgical fixation [19]. Nonetheless, this surgical approach deteriorates posterior soft tissue, blocks C1/C2 axial rotation, carries the risk of vertebral artery injury of the neck and requires bone grafting.…”

Section: Discussionmentioning

confidence: 99%

“…Authors advocating surgical treatment criticize the morbidity associated with prolonged cervical immobilisation [15] whereas authors advocating orthopaedic treatment invoke the risks of surgical intervention [2,11]. The initial surgical treatment by posterior fusion of the C1/C2 complex provides the highest fusion rates [2,8]. However, this procedure requires bone grafting, eliminates C1/C2 rotary motion, deteriorates the posterior soft tissue of the neck and includes the risk of vertebral artery injury.…”

Section: Introductionmentioning

confidence: 99%

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Anterior screw fixation of type IIB odontoid fractures in octogenarians

et al. 2011

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Purpose Type IIB odontoid fractures (OF) in elderly patients are life-threatening conditions. Optimal treatment of these fractures is still controversial. The aim of this study was to assess the clinical and radiological outcome of surgically treated type IIB OF by anterior screw fixation in octogenarians. Methods Eleven octogenarians with type IIB OF were operated using anterior screw fixation. Follow-up assessment included operative mortality and morbidity rates, long-term functional outcome and fracture union and stability. Results There was neither operative mortality nor morbidity. Five patients had excellent clinical outcome, two good outcome, one fair and three poor. Two patients died of unrelated causes 2 months after surgery. Radiographs showed stable bone union in four patients and stable fibrous union in five patients. Conclusions Given the results in this short series, we suggest that anterior screw fixation of Type IIB OF may be offered as primary treatment in octogenarians.

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Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Anterior screw fixation of type IIB odontoid fractures in octogenarians

et al. 2011

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“…Despite a high [22% (n = 6)] mortality rate in 27 elderly patients with type II odontoid fractures Frangen et al [17] found the results of dorsal C1/C2 fusion superior to halo-vest immobilization.…”

Section: Discussionmentioning

confidence: 99%

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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Introduction Type II odontoid fractures are one among the most common cervical spine fractures in the elders. We reviewed a consecutive series of patients, aged 65 years and older, presenting to our institution with type II odontoid fractures. Our analysis focused on the radiographic outcome, union rate and the development of cervical spine postural deformity. Patients/methods Indications for surgical treatment (OP) included displaced or unstable injuries. Stable, nondisplaced injuries or patients with significant co-morbidities were treated nonoperatively (non-op). Results Ninety patients (50 f, 40 m) with an average age of 83 years (65-101) were identified. 31 (34.4%) patients were received OP and 57 (63.3%) were received non-op treatments. The hospital length of stay was significantly longer after OP (mean 10 days vs. 6 days non-op) treatment (p = 0.007). At follow-up, higher union rates were noted in the OP (76.2%) than in the non-op group (58.3%). Conclusion We observed a characteristic cervical spine deformity in geriatric patients with type II odontoid fractures, and have termed this the ''Geier-deformity''. Clinical findings of the deformity include sagittal imbalance and kyphosis of the lower cervical spine.

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Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

Kaesmacher

Schweizer

Valentinitsch

et al. 2017

Journal of Bone and Mineral Research

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Traumatic odontoid fractures (TOFs) have been described as the most common injury affecting the C-spine in the elderly. Previous studies have identified degenerative changes and bone loss as important predisposing factors. However, their interaction and respective age-adjusted impact needs further clarification. We conducted a retrospective analysis of 5303 patients (aged ≥60 years) admitted to a level I trauma center between January 2008 and January 2016 who underwent CT imaging of the C-spine. Ninety-two patients with TOF and 80 patients with other cervical spine fractures (OCSF) were identified and a respective 3:1 age- and sex-matched control group without fractures after trauma was built. In all groups, cervical bone mineral density (cBMD) was determined using phantom calibration, and degenerative changes were evaluated in a qualitative manner. In all groups, the severity of degenerative changes of the C-spine increased with age (all p < 0.05) and was inversely correlated with cBMD (all p < 0.05). cBMD was the only significant predictor of a TOF in a multivariate logistic regression model (adjusted odds ratio [OR] = 3.066, 95% confidence interval [CI] 1.432-6.563 for cervical osteoporosis). An association between odontoid cysts and TOF reached significance only in Anderson and D'Alonzo (A&D) type II TOFs (aOR = 1.383; 95% CI 1.012-1.890). Patients with OCSFs, compared with patients with TOFs, were younger (median 74 versus 83 years) and had a higher cBMD (median 208 mg/mL versus 172 mg/mL). No differences were observable when comparing cBMD and grades of degenerative changes between OCSFs and their control group (all p >0.1). Decreased cBMD is the major predisposing factor for the occurrence of TOF but not for OCSF in the elderly. The severity of odontoid cysts was found to be a cBMD-independent factor associated with A&D type II TOFs. However, degenerative changes in the odontoid neighboring joints seem to be an epiphenomenon of bone loss and older age but do not independently predispose for TOF. © 2017 American Society for Bone and Mineral Research.

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Odontoid Fractures in the Elderly: Dorsal C1/C2 Fusion is Superior to Halo-Vest Immobilization

Cited by 99 publications

References 29 publications

Anterior screw fixation of type IIB odontoid fractures in octogenarians

Anterior screw fixation of type IIB odontoid fractures in octogenarians

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly

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