Surgery Can Be Appropriate for C2 Fractures in Elderly

Review, with mostly type II dens fractures, found acceptable rates of stabilization, morbidity

18 april 2009- Surgical treatment of C2 fractures in the elderly appears reasonably safe and effective, according to research published in the April issue of the Journal of Spinal Disorders & Techniques.
Ibrahim Omeis, M.D., of the New York Medical College in Valhalla, N.Y., and colleagues reviewed the cases and outcomes of 29 patients -- aged 70 to 94 years -- who were treated surgically for C2 fractures. Twenty-four of the patients had type II dens fractures alone, the other five had associated C1 fractures, and two of the 29 patients had signs and symptoms of central cord syndrome.
The researchers report that 16 patients underwent odontoid screw fixation, 15 of whom achieved successful internal fixation. Out of 13 posterior fusions, four attained osseous unions and nine were stable on flexion extension radiographs. Out of the 29 patients, 25 returned to their earlier settings (either home or nursing home), three were discharged to a nursing home, and one died perioperatively in the hospital, the report indicates.
"Type II dens fractures are relatively common in the elderly. However, the optimal approach to treatment of these fractures remains unresolved," the authors conclude. "We think surgery should not be excluded as an intervention if it seems to the treating surgeon that surgery is the better treatment modality. Our study indicates that in the presence of a type II dens fracture, surgical intervention is associated with a reasonable rate of successful fracture stabilization and a low incidence of perioperative morbidity and mortality."
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