gms | German Medical Science

67th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Korean Neurosurgical Society (KNS)

German Society of Neurosurgery (DGNC)

12 - 15 June 2016, Frankfurt am Main

Early complications, morbidity and mortality in Octo- and Nonagenarians undergoing posterior intraoperative spinal navigation based C1/2 fusion for acute traumatic odontoid type II fractures

Meeting Abstract

  • Basem Ishak - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg, Germany
  • Valerie Gimmy - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg, Germany
  • Berk Orakcioglu - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg, Germany
  • Till Schneider - Abteilung für Neuroradiologie, Universitätsklinikum Heidelberg, Germany
  • Andreas Unterberg - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg, Germany
  • Karl Kiening - Abteilung für Neurochirurgie, Universitätsklinikum Heidelberg, Germany

Deutsche Gesellschaft für Neurochirurgie. 67. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 1. Joint Meeting mit der Koreanischen Gesellschaft für Neurochirurgie (KNS). Frankfurt am Main, 12.-15.06.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. DocDI.17.06

doi: 10.3205/16dgnc201, urn:nbn:de:0183-16dgnc2014

Published: June 8, 2016

© 2016 Ishak et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objective: Odontoid type II fractures are the most common cervical spine injury in the elderly. Recent studies confirm that external stabilization is associated with high mortality and complication rates. The decision for surgical treatment is still controversial, particularly with regard to elevated perioperative risk owed to frequent comorbidities and poor bone quality. Modern navigation may help to improve perioperative safety and efficacy and thereby reduce complication rate. The aim of this study was to assess short-term mortality as well as mid-term clinical and radiological outcome in elderly.

Method: 23 patients with an acute traumatic odontoid type II fracture who underwent posterior bicortical atlanto-axial instrumentation with a modified Harms technique at our institution between January 2007 and July 2015 were retrospectively analysed and prospectively examined clinically and radiologically. Comorbidities were stratified using the age-adjusted Charlson Comorbidity Index (AACCI). Mortality, length of ICU and hospital stay were determined. The neurological and radiological outcome, blood loss, the necessity of blood transfusion as well as medical and surgical complications were evaluated. Quality of life was measured using the EQ-5D and SF-36 questionnaires at final follow-up (FU).

Results: Average age was 84.3 y (range 80 - 96 y). Mean AACCI was 7.72 which is classified as severe. In-hospital mortality was non-existent and no patient showed new permanent neurological deficits after surgery. Average length of hospital stay was 14.2 d and 2 d for ICU. Blood transfusion was necessary in one patient. Two patients developed cardio-pulmonary complications postoperatively (pneumonia, heart attack). One wound infection occurred. 15 patients were available for final FU with a mean FU of 18 months (range 3 - 72 months).The quality of life measured by EQ-5D showed a good outcome (0.73 +0.19). All SF-36 domains were reduced in comparison with the German population. Solid bony fusion could be achieved in all patients.

Conclusions: Our current study confirms that modification of the C1/C2 posterior fusion technique by using intraoperative CT-navigation is a safe and effective procedure in the elderly with few complications and preservation of favourable postoperative quality of life. Implant-related complications such as screw loosening or migration could be avoided with bicortical screw placement under navigation guidance. The overall complication rate was 13%.