gms | German Medical Science

Background: Odontoid fractures in elderly patients (>70 yrs.) occur frequently and the decision for operative or non-operative therapy is still controversial. Especially elderly patients show often a high comorbidity- and mortality rate. Additionally the quality of bone structure and ability for osteosynthesis is reduced and combined lesions of the cranio-cervical transition cannot clearly grade into the Anderson and D´Alonzo classification.

Materials and methods: All patients aged 70 or older in the period from January 2012 to December 2014 with traumatic odontoid fractures admitted to our neurosurgical department were included in a retrospective study. Age, gender, diagnosis and co-morbidities, neurostatus at admission, kind of diagnostic imaging, type of operative/non-operative procedure and complication as well as neurostatus at discharge and 3-month follow up results were assessed.

Results: 15 patients aged 70 or older (5 male/10 female, mean age 83, range 71-98 yrs) with odontoid fractures were included. Odontoid fractures classified by the Anderson and D´Alonzo classification showed 11 fractures of type II, 2 fractures of type III and 2 mixed fractures (type I+II and type II+III). In 4 cases additional lesions of the cranio-cervical transition (e.g. C1/2 dislocation, C1 fracture, pedicle fracture of C2 and vertebral arch fracture) occurred. 10 Patients (67%) present 3 or more comorbidities. Operative therapy was performed in 12 cases by anterior odontoid screw placement (10 single screw-, 2 double screw-fixation) and in one case with posterior C1/C2 fusion after halo-vest extension. In 2 cases conservative treatment with halo-vest was done. In 7 cases (47%) complications occurred (2x Dysphagia, 1x sub-arachnoid hemorrhage after odontoid screw placement, 2x pneumonia, 2x cardiac arrest). A good clinical outcome reached 8 (53%) patients (Glasgow outcome scale 4 and 5). 3 Patients (20%) died during postoperative treatment at the intensive care unit. In 3-month follow up CT-scans there were no signs of dislocation of stabilized odontoid fractures in all groups (operative and conservative).

Conclusion: Operative treatment of elderly patients (>70 yrs.) with odontoid fractures by anterior odontoid screw placement or posterior C1/C2 fusion can performed safely with acceptable good clinical results. However patient’s comorbidities should be considered for individual therapy strategies. The Anderson and D´Alonzo classification for odontoid fractures remains helpful but shows sometimes limitations in appliance.