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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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Short- to mid-term analysis of the morbidity, mortality and complications rate in nonagenarians undergoing navigated atlanto-axial fusion for acute traumatic odontoid type II fractures – a retrospective study from a prospective database

Kurz- bis mittelfristige Analyse der Morbiditäts-, Mortalitäts- und Komplikationsrate bei den über neunzig-jährigen Patientinnen, die an einer akuten traumatischen Dens-Fraktur Typ-II mit einer navigierten atlanto-axialen Fusion operiert wurden – eine retrospektive Studie aus einer prospektiven Datenbank

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  • presenting/speaker Mohammed Issa - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Karl Kiening - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland
  • Basem Ishak - Universitätsklinikum Heidelberg, Neurochirurgie, Heidelberg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocP100

doi: 10.3205/21dgnc388, urn:nbn:de:0183-21dgnc3889

Published: June 4, 2021

© 2021 Issa 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

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Objective: Odontoid type II fractures are the most common cervical spine injuries in patients over 65 years. The decision for surgical treatment in patients over 90 years of age is still controversially discussed. The aim of this study was to assess early morbidity and mortality and long-term outcome in nonagenarians undergoing atlanto-axial posterior instrumentation.

Methods: Out of 150 patients, a total of 15 patients with an acute traumatic odontoid type II fracture were retrospectively analyzed. Complications, morbidity and mortality rate, as well as length of ICU and hospital stay were determined. Clinical and radiological follow-up was conducted based on available and acquired information based patients’ family support.

Results: Mean age was 91.4 years (mean: 90-96 years). No in-hospital mortality was observed. All surgical procedures were performed uneventfully with no new neurological deficits. Five patients died during the follow-up period. Average time to death was 26.6 months. Mean length of hospital stay was 13.4 days and 1.9 days for ICU. Blood transfusion was necessary in three patients. Two patients (13%) developed urinary tract infection and one patient (7%) developed a delirium. Another patient (7%) developed a septic shock with full recovery within several weeks. The average follow-up was 36 months (10–72 months). Implant-related complications occurred in one patient (7%).

Conclusion: Our current study confirms that atlanto-axial fusion by using spinal navigation in nonagenarians is a safe and effective procedure with few complications in multi-morbid patients ages 90 years and older, demonstrating further that surgical treatment of odontoid type II fractures in nonagenarians does not negatively impact survival.