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16.03.2019 | Original Article

Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl–Gallie technique

verfasst von: Mootaz Shousha, Mohamed Alhashash, Hassan Allouch, Heinrich Boehm

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Abstract

Purpose

This single-centre retrospective study compared anterior odontoid screw fixation and posterior atlantoaxial fusion in the surgical treatment of type II B odontoid fractures according to Grauer in elderly patients.

Methods

Between 1994 and 2014, 133 consecutive patients above 60 years presenting with type II B odontoid fracture were treated surgically in our department. They were divided retrospectively into two groups. Group A included 47 patients in whom anterior odontoid screw fixation was performed. Group B with 86 patients underwent posterior atlantoaxial fusion. The clinical and radiological data were analysed. Any reoperation during the follow-up was recorded and evaluated.

Results

The mean age in group A (74.19 years) was significantly less than in group B (78.16 years). The mean operative time in group A (64.5 min) was significantly shorter than in group B (116 min). Again, the mean amount of blood loss in group A (79 ml) was significantly less than in group B (379 ml). The mean postoperative hospital stay was significantly shorter in group A (17.4 days) than in group B (30 days). The mean follow-up was 29.3 months in group A and 32 months in group B. The rate of pseudoarthrosis was significantly higher in group A (25.5%) than in group B (3.5%). Furthermore, the need for revision surgery was significantly increased in group A (23.4%) than in group B (10.47%).

Conclusions

Odontoid screw fixation is a less invasive surgery for type II B odontoid fractures in elderly patients. However, posterior atlantoaxial fusion provides a superior surgical outcome regarding fracture healing and the need for surgical revisions.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Chapman J, Smith JS, Kopjar B, Vaccaro AR, Arnold P, Shaffrey CI, Fehlings MG (2013) The AO Spine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976) 38(13):1098–1104CrossRef

Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56(8):1663–1674CrossRef

Grauer JN, Shafi B, Hilibrand AS, Harrop JS, Kwon BK, Beiner JM, Albert TJ, Fehlings MG, Vaccaro AR (2005) Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J 5(2):123–129CrossRefPubMed

Dobran M, Nasi D, Esposito DP, Iacoangeli M (2016) Posterior fixation with C1 lateral mass screws and C2 pars screws for type II odontoid fracture in the elderly: long-term follow-up. World Neurosurg 96:152–158CrossRefPubMed

Joestl J, Lang N, Bukaty A, Platzer P (2016) A comparison of anterior screw fixation and halo immobilisation of type II odontoid fractures in elderly patients at increased risk from anaesthesia. Bone Joint J 98(B(9)):1222–1226CrossRefPubMed

Woods BI, Hohl JB, Braly B, Donaldson W III, Kang J, Lee JY (2014) Mortality in elderly patients following operative and nonoperative management of odontoid fractures. J Spinal Disord Tech 27(6):321–326CrossRef

Ryang YM, Török E, Janssen I, Reinke A, Buchmann N, Gempt J, Ringel F, Meyer B (2016) Early morbidity and mortality in 50 very elderly patients after posterior atlantoaxial fusion for traumatic odontoid fractures. World Neurosurg 87:381–391CrossRef

Loehrer L, Raschke MJ, Thiesen D, Hartensuer R, Surke C, Ochman S et al (2012) Current concepts in the treatment of Anderson type II odontoid fractures in the elderly in Germany, Austria and Switzerland. Inj J Care Inj 43:462–469CrossRef

Bórm W, Kast E, Richter HP, Mohr K, Sonntag VKH, Benzel EC et al (2003) Anterior screw fixation in type II odontoid fractures: Is there a difference in outcome between age groups? Neurosurgery 52:1089–1094PubMed

10.

Magerl F, Seemann P-S (1987) Stable posterior fusion of the atlas and axis by transarticular screw fixation. Cerv Spine I. https://doi.org/10.1007/978-3-7091-8882-8_59

11.

Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26:2467–2471CrossRef

12.

Frangen TM, Zilkens C, Muhr G, Schinkel C (2007) Odontoid fractures in the elderly: dorsal C1/C2 fusion is superior to halo-vest immobilization. J Trauma Inj Infect Crit Care 63:83–89CrossRef

13.

Konieczny MR, Gstrein A, Müller EJ (2012) Treatment algorithm for dens fractures: non-halo immobilization, anterior screw fixation, or posterior transarticular C1–C2 fixation. J Bone Joint Surg Am 94:e144(1–6)CrossRef

14.

Gallie W (1939) Fractures and dislocations of the cervical spine. Am J Surg 46:495–499CrossRef

15.

Faure A, Graillon T, Pesenti S, Tropiano P, Blondel B, Fuentes S (2017) Trends in the surgical management of odontoid fractures in patients above 75 years of age: retrospective study of 70 cases. Orthop Traumatol Surg Res 103(8):1221–1228CrossRef

16.

Schroeder GD, Kepler CK, Kurd MF, Paul JT, Rubenstein RN, Harrop JS, Brodke DS, Chapman JR, Vaccaro AR (2015) A systematic review of the treatment of geriatric type II odontoid fractures. Neurosurgery 77(Suppl 4):S6–S14CrossRefPubMed

17.

Robinson Y, Robinson AL, Olerud C (2014) Systematic review on surgical and nonsurgical treatment of type II odontoid fractures in the elderly. Biomed Res Int 2014:231948CrossRefPubMedPubMedCentral

18.

DePasse JM, Palumbo MA, Ahmed A, Adams CA, Daniels AH (2016) Halo-vest immobilization in elderly odontoid fracture patients: evolution in treatment modality and in-hospital outcomes. Clin Spine Surg 30(9):E1206–E1210. https://doi.org/10.1097/BSD.0000000000000483 CrossRef

19.

Patterson JT, Theologis AA, Sing D, Tay B (2017) Anterior versus posterior approaches for odontoid fracture stabilization in patients older than 65 years: 30-day morbidity and mortality in a national database. Clin Spine Surg 30(8):E1033–E1038CrossRef

20.

Shen Y, Miao J, Li C, Fang L, Cao S, Zhang M, Yan J, Kuang Y (2015) A meta-analysis of the fusion rate from surgical treatment for odontoid factures: anterior odontoid screw versus posterior C1–C2 arthrodesis. Eur Spine J 24(8):1649–1657CrossRef

21.

Iyer S, Hurlbert RJ, Albert TJ (2018) Management of odontoid fractures in the elderly: a review of the literature and an evidence-based treatment algorithm. Neurosurgery 82(4):419–430CrossRef

22.

Wagner SC, Schroeder GD, Kepler CK, Schupper AJ, Kandziora F, Vialle EN, Oner C, Fehlings MG, Vaccaro AR (2017) Controversies in the management of geriatric odontoid fractures. J Orthop Trauma 31(Suppl 4):S44–S48CrossRefPubMed

23.

Han B, Li F, Chen G, Li H, Chen Q (2015) Motion preservation in type II odontoid fractures using temporary pedicle screw fixation: a preliminary study. Eur Spine J 24(4):686–693CrossRefPubMed

24.

Guo Q, Zhang M, Wang L, Lu X, Guo X, Ni B (2016) Comparison of atlantoaxial rotation and functional outcomes of two nonfusion techniques in the treatment of Anderson–D’Alonzo type II odontoid fractures. Spine (Phila Pa 1976) 41(12):E751–E758CrossRef

25.

Kuhlman KA (1993) Cervical range of motion in the elderly. Arch Phys Med Rehabil 74(10):1071–1079CrossRefPubMed

26.

Greaves LL, Van Toen C, Melnyk A, Koenig L, Zhu Q, Tredwell S, Mulpuri K, Cripton PA (2009) Pediatric and adult three-dimensional cervical spine kinematics: effect of age and sex through overall motion. Spine 34(Spine (Phila Pa 1976)):1650–1657CrossRefPubMed

27.

Alhashash M, Shousha M, Gendy H, Barakat AS, Boehm H (2018) Percutaneous posterior transarticular atlantoaxial fixation for the treatment of odontoid fractures in the elderly: a prospective study. Spine (Phila Pa 1976) 43(11):761–766CrossRef

28.

Štulík J, Hodasová G, Podhráský M, Nesnídal P, Fojtík P, Naňka O (2018) Anatomy of the dens and its implications for fracture treatment: an anatomical and radiological study. Eur Spine J. https://doi.org/10.1007/s00586-018-5793-8 CrossRefPubMed

Titel: Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl–Gallie technique
verfasst von: Mootaz Shousha
Mohamed Alhashash
Hassan Allouch
Heinrich Boehm
Publikationsdatum: 16.03.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: European Spine Journal
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-05946-x

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Springer Medizin

Surgical treatment of type II odontoid fractures in elderly patients: a comparison of anterior odontoid screw fixation and posterior atlantoaxial fusion using the Magerl–Gallie technique

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

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Springer Medizin

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Methods

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Conclusions

Graphical abstract

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Arthropedia

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Ärztliche Empathie hilft gegen Rückenschmerzen

Stereotaktische Radiatio schlägt konventionelle Bestrahlung

Vorsicht mit hohen NSAR-Dosen bei ankylosierender Spondylitis!

Update Orthopädie und Unfallchirurgie