Issa Mohammed, Kiening Karl L, Unterberg Andreas W, Scherer Moritz, Younsi Alexander, Fedorko Stepan, Oskouian Rod J, Chapman Jens R, Ishak Basem
Department of Neurosurgery, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Complex Spine Surgery, Swedish Neuroscience Institute, Seattle, WA 98122, USA.
J Clin Med. 2021 Aug 24;10(17):3780. doi: 10.3390/jcm10173780.
Odontoid type II fractures represent the most common cervical spine injuries in the elderly. The decision for surgical treatment in very elderly patients is still controversial. The aim of this study was to assess morbidity and mortality in patients over 90 years of age undergoing CT-guided posterior stabilization for unstable odontoid type II fractures. A total of 15 patients with an acute traumatic odontoid type II fracture who received surgical treatment for unstable odontoid type II fractures were retrospectively analyzed. Complications, morbidity, and mortality as well as length of ICU and hospital stay were determined. Clinical follow-up evaluation was based on outpatient presentation and information from family members and general practitioners. Finally, we conducted a comparison of complications rates between patients over 90 years of age and patients between 65 and 89 years old with a type II odontoid fracture after CT-guided posterior stabilization in our institution. The mean age was 91.4 years. Patients were predominately female (87%). In-hospital deaths did not occur. The average length of the hospital stay was 13.4 days and 1.9 days for the ICU. Blood transfusion was necessary in two patients (13%). Two patients (13%) developed urinary tract infection, one patient (7%) a delirium, and another epistaxis (7%). One patient (7%) developed pneumonic sepsis and fully recovered within several weeks. The mean follow-up was 36 months (range 9-72 months). Implant-related complications developed in one patient (7%). Five patients died during the follow-up period, with an average time to death of 26.6 months. Postoperative bracing was not needed in any of the patients. Posterior stabilization of unstable odontoid fractures type II using CT-guided navigation in patients over 90 years of age is a safe and effective procedure with low complications and mortality rates.
齿状突II型骨折是老年人中最常见的颈椎损伤。对于高龄患者的手术治疗决策仍存在争议。本研究的目的是评估90岁以上因不稳定齿状突II型骨折接受CT引导下后路稳定术患者的发病率和死亡率。对15例因急性创伤性齿状突II型骨折接受不稳定齿状突II型骨折手术治疗的患者进行回顾性分析。确定并发症、发病率、死亡率以及重症监护病房（ICU）住院时间和住院总时长。临床随访评估基于门诊表现以及家庭成员和全科医生提供的信息。最后，我们对本院90岁以上患者与65至89岁齿状突II型骨折患者在CT引导下后路稳定术后的并发症发生率进行了比较。平均年龄为91.4岁。患者以女性为主（87%）。住院期间无死亡病例。平均住院时间为13.4天，ICU住院时间为1.9天。两名患者（13%）需要输血。两名患者（13%）发生尿路感染，一名患者（7%）出现谵妄，另一名患者（7%）鼻出血。一名患者（7%）发生肺炎性败血症并在数周内完全康复。平均随访时间为36个月（范围9 - 72个月）。一名患者（7%）出现植入物相关并发症。5例患者在随访期间死亡，平均死亡时间为26.6个月。所有患者术后均无需支具固定。90岁以上患者采用CT引导导航对不稳定齿状突II型骨折进行后路稳定术是一种安全有效的手术，并发症和死亡率较低。
