Article
Odontoid fractures in elderly patients: Posterior C1-C2 fixation as first surgical option?
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Authors
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H.-J. Becker
- Service Neurochirurgie, Hôpitaux Universitaires de Genève
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E. Tessitore
- Service Neurochirurgie, Hôpitaux Universitaires de Genève
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K. Schaller
- Service Neurochirurgie, Hôpitaux Universitaires de Genève
| Published: | May 20, 2009 |
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Outline
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Objective: Type II odontoid fractures are the most common cervical spine fractures in elderly patients (>70y). However, the choice of initial treatment is still a matter of controversy. Anterior odontoid screw fixation is a widely accepted technique to treat these fractures, independent from the patient’s age. Nonetheless, pseudarthrosis is a frequent problem in elderly patients – often due to poor bone quality. The authors report on their experience with posterior C1-C2 fixation for managing pseudarthrosis after initial anterior screw fixation in elderly patients.
Methods: In a retrospective analysis from 2005 to 2008 we found out thirteen patients with type II odontoid fractures treated by anterior screw fixation. Eight out of thirteen patients were >70 years old. From these, 4 (50%) developed clinically and radiographically documented pseudarthrosis. Demographic data, fracture type, trauma mechanism, surgical technique and complications were reviewed. Pain was the leading complaint. All patients underwent subsequent posterior fixation/fusion with C1 lateral mass screws, C2 isthmic screws and posterior iliac crest autograft. Clinical and radiological follow-up was performed at 3, 6, and 12 months.
Results: All patients showed clinical improvement regarding pre-existing pain. All patients showed C1-C2 stability and fusion at the last radiological follow-up. No neurological or vascular complications occurred. One patient presented with a posterior iliac crest harvesting complication.
Conclusions: Posterior C1-C2 fixation is an adequate and safe method of treatment in elderly patients with C2 pseudarthrosis after anterior screw fixation. Furthermore, it should be considered as an effective first line treatment in this particular group due to the high failure rate of anterior odontoid screw fixation.
