Article
90-day morbidity and mortality rate in nonagenarians undergoing intraoperative spinal navigation based atlanto-axial fusion for acute traumatic odontoid type II fractures
90-Tage-Morbiditäts- und Mortalitätsrate bei über 90-jährigen Patienten, die an einer atlantoaxialen Fusion bei akut traumatischen odontoiden Typ-II-Frakturen mit Hilfe der intraoperativen spinalen Navigation operiert wurden
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Published: | June 26, 2020 |
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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 complication and mortality rates. The decision for surgical treatment is the very elderly is still controversial, particularly with regard to comorbidities and poor bone quality. The aim of this study was to assess early morbidity and mortality in nonagenarians.
Methods: 15 patients with an acute traumatic odontoid type II fracture who underwent posterior CT-guided atlanto-axial instrumentation at our institution between February 2010 and October 2019 were retrospectively analysed. Complication, morbidity and mortality rate, as well as length of ICU and hospital stay were determined.
Results: Average age was 91 years (range 90 – 96 y). In-hospital mortality was non-existent and no patient showed new permanent neurological deficits after surgery. One C2 screw was misplaced into the vertebral canal without any symptoms. Average length of hospital stay was 13.4 days and 2 days for ICU. Blood transfusion was necessary in three patients. Two patients (13%) developed urinary tract infection. One patient (7%) developed pulmonary embolism with fully recovery within several weeks.
Conclusion: Our current study confirms that atlanto-axial fusion by using intraoperative CT-navigation in nonagenarians is a safe and effective procedure with few complications. Implant-related complications occurred in one patient (7%). 90-day mortality rate was 0%.