Wagner Scott C, Schroeder Gregory D, Kepler Christopher K, Schupper Alexander J, Kandziora Frank, Vialle Emiliano N, Oner Cumhur, Fehlings Michael G, Vaccaro Alexander R
*Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA; †Center for Spine Surgery and Neurotraumatology, BG Unfallklinik Frankfurt am Main, Frankfurt, Germany; ‡Spine Surgery Group, Department of Orthopedics, Cajuru Hospital, Catholic University of Paraná, Curitiba, Brazil; §Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands; ‖Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; ¶Institute of Medical Science, University of Toronto, Toronto, ON, Canada; **McEwen Centre for Regenerative Medicine, UHN, University of Toronto, Toronto, ON, Canada; ††Spine Program, University of Toronto, Toronto, ON, Canada; ‡‡McLaughlin Center in Molecular Medicine, University of Toronto, Toronto, ON, Canada; and §§Genetics and Development, Krembil Discovery Tower, Toronto Western Hospital, Toronto, ON, Canada.
J Orthop Trauma. 2017 Sep;31 Suppl 4:S44-S48. doi: 10.1097/BOT.0000000000000948.
Fractures of the odontoid process of C2 have become increasingly prevalent in the aging population and are typically associated with a high incidence of morbidity. Dens fractures comprise the majority of all cervical fractures in patients older than 80 years and remain the most common cervical fracture pattern in all geriatric patients. Type II odontoid fractures have been associated with limited healing potential, and both nonoperative and operative management are associated with high mortality rates. Historically, there has been some debate in the literature with regards to optimal management strategies to maximize outcomes in geriatric patients. Recent, high-quality evidence has indicated that surgical treatment of type II odontoid fractures in elderly patients is associated with improvements in both short- and long-term mortality. Additionally, surgical intervention has been shown to improve functional outcomes when compared with nonsurgical treatment. Factors to consider before surgery for geriatric type II odontoid fractures include associated comorbidities and the safety of general anesthesia administration. With appropriate measures of patient selection, surgery can provide an efficacious option for geriatric patients with type II odontoid fractures. We recommend surgical intervention via a posterior C1-C2 arthrodesis for geriatric type II odontoid fractures, provided that the surgery itself does not represent an unreasonable risk for mortality.
C2齿突骨折在老年人群中越来越普遍，通常与高发病率相关。齿突骨折占80岁以上患者所有颈椎骨折的大多数，并且仍然是所有老年患者中最常见的颈椎骨折类型。II型齿突骨折愈合潜力有限，非手术和手术治疗均与高死亡率相关。从历史上看，文献中对于老年患者最佳治疗策略以实现最佳治疗效果存在一些争议。最近的高质量证据表明，老年患者II型齿突骨折的手术治疗与短期和长期死亡率的改善相关。此外，与非手术治疗相比，手术干预已被证明可改善功能结局。老年II型齿突骨折手术前需要考虑的因素包括相关合并症和全身麻醉给药的安全性。通过适当的患者选择措施，手术可以为老年II型齿突骨折患者提供有效的选择。我们建议对老年II型齿突骨折采用C1-C2后路关节融合术进行手术干预，前提是手术本身不会带来不合理的死亡风险。
