gms | German Medical Science

Objective: The majority of traumatic odontoid fractures are pertained to geriatric patients well beyond 65 years of age. Frailty, abundancy of comorbidities and a high morbidity and mortality rate pose a not to be underestimated challenge to today's spine surgeons. The optimal treatment (surgical vs conservative) of this difficult patient cohort is still controversially discussed. In this cohort study surgically treated patients 80 years or older were analyzed with respect to comorbidities, perioperative complications (medical and surgery-related) and mortality.

Method: Forty pats. (13 m /27 f, mean age 87 yrs, range 80-94 yrs) with traumatic odontoid fractures who were treated surgically with dorsal C1/C2 fixation from April 2008 until September 2013 were included. Neurostatus (pre/postop), relevant comorbidities, intra- and perioperative complications (surgery related/medical), length of ICU/hospital stay and the mortality rate were assessed.

Results: 30 (75%) pats. were treated for acute odontoid fractures, 10 (25%) pats. for failed previous conservative treatment with pseudarthrosis and / or persistent nuchalgia (mean 3.7 ± 5.5 months; range 0.75–18). Mean duration of surgery was 120 ± 33 min (56–197), mean length of hospital stay 15 ± 10 days (4–56) and mean follow up time was 10.2 ± 12 months (0.5–57). There was no in-hospital mortality. 8 (20%) pats. deceased 0.5–15 months after surgery (mean 5.2 ± 5.3). 8 (20%) pats. were lost to FU. All pats. (100%) had at least 1 relevant medical disorder (mean 3 ± 2; range 1–7). 6 (15%) pats. Experienced 10 preoperative complications, 6 (15%) pats. Surgery-related complications and 22 (55%) pats. Suffered from 37 postoperative complications. 5 (12.5%) pats. Needed revision surgeries. 6 (15%) pats. Had a neurological deficit preop, this improved in 1 (2.5%), 5 (12.5%) were unchanged postoperatively. There was no postop deterioration or new deficit. 10 (25%) pats. Needed ICU treatment (mean 1.5 ± 3.5 d, range 1–13).

Conclusions: While the rate of surgery related complications and revision surgeries was relatively low with no postop neurological deterioration or new neurological deficit, this patient group experienced a high rate of nonsurgical complications resulting in a prolonged hospitalization and high rate of ICU treated patients. Whether surgery is the treatment of choice in the very elderly or whether these geriatric patients would benefit more from conservative therapy is still unclear.