Article
Posterior fixation of complex atlantoaxial fractures with screws, screw/rod and occiput plate systems using C-arm fluoroscopy in octo- and nonagenarian patients
Posteriore Fixation komplexer atlantoaxialer Frakturen mit Schrauben-, Schrauben-Stab- und Occiputplattensystemen mittels C-Bogen-Fluoroskopie in über 80-jährigen Patienten
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Authors
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Paul Oni
- Klinikum Dortmund, Neurochirurgie, Dortmund, Deutschland
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Oliver Müller
- Klinikum Dortmund, Neurochirurgie, Dortmund, Deutschland
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Rolf Schultheiß
- Klinikum Dortmund, Neurochirurgie, Dortmund, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: Complex atlantoaxial fractures are associated with high mortality rates in elderly patients. Surgical management of these fractures in octo- and nonagenarian patients remains debatable. We report on our experience with posterior fusion of these cases.
Methods: The subjects were 19 females and 11 males who had undergone posterior fusion for atlantoaxial fractures using c-arm fluoroscopy between January 2008 and September 2019 in our clinic. The mean age at surgery was 85±3.3 years (27 cases 80-89 yrs., 3 cases 90-91 yrs.) and mean follow-up was 11.4 months. All patients had pre- and postoperative CT scan. All 30 cases had C2 fractures consisting of 19 Type II and 8 Type III odontoid fractures, 2 C2 burst fracture and 1 C2 superior articular facet fracture with atlantoaxial rotatory subluxation. 10 (30%) cases had additional C1 fracture and in 24 (80%)cases C1/2 facet dislocation was present. Falls from a standing height accounted for 83% of injuries. The following parameters were assessed: fracture repositioning, bone union, length of hospital stay, complications, mortality rate and neurological status by Frankel scale
Results: Posterior C1/2 fusion was performed in 19 cases (15 C1/2 fusion by Harms, 2 C1/2 transarticular screws by Magerl and 2 C1/2 transarticular screw with C1 lateral mass screw). 7 cases were treated with occipitocervical fusion; 4 cases had extension of C1 fusion to subaxial spine. The mean operative time and hospital stays were 105 mins and 10.4 days (mean ICU Stay 1.7 days). There was no in hospital mortality. The 30-day and 3-month mortality were 0% and 10% respectively. Fracture reposition was obtained in all cases. But for the 3 patients lost during follow-up bone union was 100%. There were no adverse events such as spinal cord or vertebral artery injury, uncontrolled bleeding or cerebrospinal fluid leakage. There were 3 cases of severe delirium, 6 urinary tract- and 3 lung infections. No wound infection occurred. Postoperatively, Frankel scale was unchanged in 28 patients. There was a one point increase in 1 patient and a one point decrease in another.
Conclusion: Posterior fusion with screws, screw/rod and occiput plate systems using c-arm fluoroscopy are reliable and effective in surgical management of atlantoaxial fractures in octo- and nonagenarian patients
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