[Cervical spine injuries in the elderly patient].

Studies have shown that the numbers of injuries of the cervical spine increase in elderly patients. An early clinical examination and adequate diagnostics are necessary to initiate the appropriate treatment. A computed tomography (CT) scan is recommended to exclude injuries of the cervical spine. Dynamic fluoroscopy and magnetic resonance imaging (MRI) can additionally be helpful to detect instabilities. The treatment of the injury depends on the extent of the fracture and includes conservative treatment options with soft or rigid ortheses for cervical spine immobilization, retention with a halo fixator or open/closed reduction and fixation. In the selection of treatment it should be taken into consideration that the use of rigid immobilization or a halo fixator is associated with a significant reduction of the quality of life. In the region of the upper cervical spine only unstable fractures of the atlas and of the axis should be operatively treated. In the region of the subaxial cervical spine fractures are prone to be unstable due to the lack of flexibility of the cervical spine in elderly patients. Therefore, fractures of types B and C according to AO Spine, for which operative treatment is recommended, are regularely seen. In addition, a pre-existing stenosis of the spinal cord may lead to neurological symptoms which negatively influence the clinical outcome.