CT evaluation of the pattern of odontoid fractures in the elderly?relationship to upper cervical spine osteoarthritis (original) (raw)
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Osteoporosis Is the Most Important Risk Factor for Odontoid Fractures in the Elderly
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2017
Traumatic odontoid fractures (TOFs) have been described as the most common injury affecting the C-spine in the elderly. Previous studies have identified degenerative changes and bone loss as important predisposing factors. However, their interaction and respective age-adjusted impact needs further clarification. We conducted a retrospective analysis of 5303 patients (aged ≥60 years) admitted to a level I trauma center between January 2008 and January 2016 who underwent CT imaging of the C-spine. Ninety-two patients with TOF and 80 patients with other cervical spine fractures (OCSF) were identified and a respective 3:1 age- and sex-matched control group without fractures after trauma was built. In all groups, cervical bone mineral density (cBMD) was determined using phantom calibration, and degenerative changes were evaluated in a qualitative manner. In all groups, the severity of degenerative changes of the C-spine increased with age (all p < 0.05) and was inversely correlated wi...
European Spine Journal, 2011
Introduction Type II odontoid fractures are one among the most common cervical spine fractures in the elders. We reviewed a consecutive series of patients, aged 65 years and older, presenting to our institution with type II odontoid fractures. Our analysis focused on the radiographic outcome, union rate and the development of cervical spine postural deformity. Patients/methods Indications for surgical treatment (OP) included displaced or unstable injuries. Stable, nondisplaced injuries or patients with significant co-morbidities were treated nonoperatively (non-op). Results Ninety patients (50 f, 40 m) with an average age of 83 years (65-101) were identified. 31 (34.4%) patients were received OP and 57 (63.3%) were received non-op treatments. The hospital length of stay was significantly longer after OP (mean 10 days vs. 6 days non-op) treatment (p = 0.007). At follow-up, higher union rates were noted in the OP (76.2%) than in the non-op group (58.3%). Conclusion We observed a characteristic cervical spine deformity in geriatric patients with type II odontoid fractures, and have termed this the ''Geier-deformity''. Clinical findings of the deformity include sagittal imbalance and kyphosis of the lower cervical spine.
Odontoid Fractures and Their Management
Topics in Spinal Cord Injury Rehabilitation, 2010
Odontoid fractures are the most common cervical spine fracture in the elderly, and their incidence is increasing. The majority of these fractures are Type II and are associated with significant morbidity in the elderly population, irrespective of treatment options (surgical vs. nonsurgical). There is no clear consensus regarding the long-term morbidity of nonunion, with some authors advocating stable fibrous nonunion as an acceptable endpoint versus bony union. Surgical management is advocated by some due to the significantly greater union rate, and some studies report improved outcomes with surgery. Prospective studies are needed to better delineate optimal treatment.
Neurosurgery, 2018
Odontoid fractures are the most common fracture of the axis and the most common cervical spine fracture in patients over 65. Despite their frequency, there is considerable ambiguity regarding optimal management strategies for these fractures in the elderly. Poor bone health and medical comorbidities contribute to increased surgical risk in this population; however, nonoperative management is associated with a risk of nonunion or fibrous union. We provide a review of the existing literature and discuss the classification and evaluation of odontoid fractures. The merits of operative vs nonoperative management, fibrous union, and the choice of operative approach in elderly patients are discussed. A treatment algorithm is presented based on the available literature. We believe that type I and type III odontoid fractures can be managed in a collar in most cases. Type II fractures with any additonal risk factors for nonunion (displacement, comminution, etc) should be considered for surgic...
Odontoid fractures account for approximately 7-15% (1) of cervical spine fractures, and almost 60% of fractures involving the axis. Neurological involvement is seen in upto 25% pts (2), and the primary mortality rate is around 12% (2). The mean age of occurrence is 47 years, with 2 peaks. In younger individuals, the fracture usually occurs due to a high velocity injury. In the elderly, hyperextension of the head and neck during domestic falls is the most common mode of injury. These injuries are frequently missed in the elderly, and the mortality is higher as compared to younger patients.
Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal?
European Spine Journal, 2019
Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Methods: 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin scale (mRS-pre) and Charlson Comorbidity Index (CCI). 12-15 months after treatment, functional evaluations were performed employing a second modified Rankin scale (mRS-post) together with Neck Disability Index (NDI) and Smiley Webster Pain Scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine x-rays at 3 months and cervical spine CT scans 6 months after treatment. Three different conditions were identified: stable union, stable nonunion, unstable nonunion. Results: Among the 50 patients, 24 reached a stable union while 26 a stable nonunion. Comparing the two groups, no differences of ASA (p=0.60), CCI (p=0.85) and mRS-pre (p=0.14) were noted. Similarly, no differences of mRS-post (p=0.96), SWPS (p=0.85)
European Spine Journal, 2011
In the elderly population, reported union rates with anterior odontoid screw fixation (AOSF) for odontoid fracture (OF) treatment vary between 23 and 93% when using plain radiographs. However, recent research revealed poor interobserver reliability for fusion assessment using plain radiographs compared to CT scans. Therefore, union rates in patients aged C60 years treated with AOSF have to be revisited using CT scans and factors for non-union to be analysed. Prospectively gathered consecutively treated patients using AOSF for odontoid fracture with age C60 years were reviewed. Medical charts were assessed for demographics, clinical outcomes and complications. Patients' preoperative radiographs and CT scans were analysed to characterize fracture morphology and type, fracture displacement, presence of atlanto-dental osteoarthritis as well as a detailed morphometric assessment of fracture surfaces (in mm 2 ). CT scans performed after a minimum of 3 months postoperatively were analysed for fracture union. Those patients not showing CT-based evidence of completely fused odontoid fracture were invited for radiographic follow-up at a minimum of 6 months follow-up. Follow-up CT-scan were studied for odontoid union as well as the number of screws used and the square surface of screws used for AOSF and the related corticocancellous osseous healing surface of the odontoid fragment (in %) were calculated. Patients were stratified whether they achieved osseous union or fibrous non-union. Patients with a non-union were subjected to flexionextension lateral radiographs and the non-union defined as stable if no motion was detected. The sample included 13 male (72%) and 5 female (18%) patients. The interval from injury to AOSF was 4.1 ± 5.3 days (0-16 days). Age at injury was 78.1 ± 7.6 years (60-87 years) and follow-up was 75.7 ± 50.8 months (4.2-150.2 months). 10 patients had dislocated fractures, 14 had Type II and 4 ''shallow'' Type III fractures according to the Anderson classification, 2 had stable C1-ring fractures, 8 had displayed atlantodental osteoarthritis. Fracture square surface was 127.1 ± 50.9 mm 2 (56.3-215.9 mm 2 ) and osseous healing surface was 84.0 ± 6.8% (67.6-91.1%). CT-based analysis revealed osseous union in 9 (50%) and non-union in 9 patients (50%). Union rates correlated with increased fracture surface (P = 0.02). Statistical analysis revealed a trend that the usage of two screws with AOSF correlates with increased fusion rates (P = 0.06). Stability at C1-2 was achieved in 89% of patients. CT scans are accepted as the standard of reference to assess osseous union. The current study offers an objective insight into the union rates of odontoid fractures treated with AOSF using CT scans in consecutive series of 18 patients C60 years. Literature serves evidence that elderly patients with unstable OF benefit from early surgical stabilization. However, although using AOSF for unstable OF yields segmental stability at C1-2 in a high number of patients as echoed in
Archives of orthopaedic and trauma surgery, 2018
The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment. Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D'Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation. Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. Ge...