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Upper cervical spinal injuries in elderly patients: age-specific treatment

Incidence of upper cervical vertebra injuries in elder population augments in accordance with the increase in mean life expectancy of the general population. These injuries can be easily misdiagnosed since they can be caused by low-accelerated traumas due to the osteo-degenerative changes in elderly patients, and with generally no neurological findings. Odontoid fractures are the most common among these injuries. Treatment algorithms of odontoid fractures are not still well established because of preexisted co-morbidities and high rates of morbidity and mortality in older individuals. We have retrospectively evaluated 16 cases admitted to our clinic in last 3 years, which were older than 65 years of age and which have been diagnosed with C2 fractures. In 13 of these cases (81.3%) odontoid fractures (10 cases with type II and 3 cases with type III), in 2 cases (12.5%) lateral mass fractures and 1 pars interarticularis fracture were identified. 14 of the patients (87.5%) were treated with medical corsets (7 Halo vests, 7 Minerva braces) and 2 patients (12.5%) had undergone surgery. All patients who had rigid cervical immobilization (RCI) were discharged in cured conditions whereas 2 patients, who were treated with surgical intervention, had died in early post-operative period. In patients with RCI bone fusion rate was 63.6% and recovery with stable fibrosis rate was 36.4% for odontoid fractures. At the end of the medical corset application period, all patients were checked with dynamic X-ray imaging and in an unrelated manner to the bone fusion rates no instability, greater than 1 mm, was determined. In the mean follow-up period of 30 months, no complications were seen after the medical corset application for stabilizations. Therefore, we have the conclusion that in patients from the older population, with no certain indications for surgery, a suitable RCI should be tried at first, and recovery with a stable fibrosis can be adequate for this patient group.

Author(s): Ali Riza Gezici, Yasar Dagistan, Se├žkin Emre Cancan*, Kutlu Sari, Necdet Selim Kaya, G├╝ven Kili├ž, Semih Akar