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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 11, pp 1525–1531 | Cite as

Odontoid fractures in combination with C1 fractures in the elderly treated by combined anterior odontoid and transarticular C1/2 screw fixation

  • Christoph Josten
  • Jan-Sven Jarvers
  • Stefan Glasmacher
  • Ulrich J. Spiegl
Trauma Surgery
  • 66 Downloads

Abstract

Introduction

The purpose of this study was to evaluate risk factors of accompanied C1 fractures in elderly patients with type II odontoid fractures (OF) and to analyze the complication rate and the outcomes of patients after combined anterior odontoid and transarticular C1/2 screw fixation (AOTAF).

Materials and methods

The study represents a retrospective case series at a single level-1 trauma center. All elderly patients (≥ 70 years) with acute combination injuries (CI) including type II OF with an accompanied C1 fracture, who were treated by an anterior approach, were included. All postoperative complications were analyzed based on the patient notes. Clinical and radiological controls were performed after 1 year. Main parameters of interest were 1-year mortality rate, pain level, and satisfaction rate after 1 year.

Results

A total of 23 patients were included. The average age was 84.6 years (range 73–94 years). All patients had atlanto-odontoid osteoarthritis (AOO) and all but two patients were injured by low-energy falls. Dysphagia was the most common postoperative complication (26.1%). Surgical revision was necessary in one of these patients due to hematoma. Dysphagia improved in all patients considerably. Loss of follow-up was 21.7%. The 1-year mortality was 21.7% (n = 5). The mean pain level and satisfaction rate was 2.5 (± 0.9) and 7.3 (± 0.7), respectively. After 1 year, no signs of non-union were visible.

Conclusions

AOO was observed in all patients with CI. The main cause of trauma was a low-energy fall. The pain levels were low to moderate and satisfaction levels were promising 1 year after surgery. Nonetheless, AOTAF is associated with a high rate of postoperative dysphagia, which resolves in the majority of patients due to conservative management.

Keywords

Type II odontoid fracture Atlas fracture Elderly patients Anterior approach Complications 

Notes

Acknowledgements

The authors are thankful to Jocelyn Todd for her proof reading.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that there is no conflict of interest.

References

  1. 1.
    Gleizes V, Jacquot FP, Signoret F, Feron JM (2000) Combined injuries in the upper cervical spine: clinical and epidemiological data over a 14-year period. Eur Spine J 9:386–392CrossRefGoogle Scholar
  2. 2.
    Guiot B, Fessler RG (1999) Complex atlantoaxial fractures. J Neurosurg 91:139–143CrossRefGoogle Scholar
  3. 3.
    Hanigan WC, Powell FC, Elwood PW, Henderson JP (1993) Odontoid fractures in elderly patients. J Neurosurg 78:32–35.  https://doi.org/10.3171/jns.1993.78.1.0032 CrossRefPubMedGoogle Scholar
  4. 4.
    Spivak JM, Weiss MA, Cotler JM, Call M (1994) Cervical spine injuries in patients 65 and older. Spine (Phila Pa 1976) 19:2302–2306CrossRefGoogle Scholar
  5. 5.
    Dickman CA, Hadley MN, Browner C, Sonntag VK (1989) Neurosurgical management of acute atlas-axis combination fractures. A review of 25 cases. J Neurosurg 70:45–49.  https://doi.org/10.3171/jns.1989.70.1.0045 CrossRefPubMedGoogle Scholar
  6. 6.
    Apostolides PJ, Theodore N, Karahalios DG, Sonntag VK (1997) Triple anterior screw fixation of an acute combination atlas-axis fracture. Case report. J Neurosurg 87:96–99.  https://doi.org/10.3171/jns.1997.87.1.0096 CrossRefPubMedGoogle Scholar
  7. 7.
    Daentzer D, Florkemeier T (2009) Conservative treatment of upper cervical spine injuries with the halo vest: an appropriate option for all patients independent of their age? J Neurosurg Spine 10:543–550.  https://doi.org/10.3171/2009.2.SPINE08484 CrossRefPubMedGoogle Scholar
  8. 8.
    Wu AM, Wang XY, Chi YL, Xu HZ, Weng W, Huang QS, Ni WF (2012) Management of acute combination atlas-axis fractures with percutaneous triple anterior screw fixation in elderly patients. Orthop Traumatol Surg Res OTSR 98:894–899.  https://doi.org/10.1016/j.otsr.2012.09.006 CrossRefPubMedGoogle Scholar
  9. 9.
    Josten C, Jarvers JS, Glasmacher S, Heyde CE, Spiegl U (2016) Anterior transarticular atlantoaxial screw fixation in combination with dens screw fixation for type II odontoid fractures with associated atlanto-odontoid osteoarthritis. Eur Spine J 25:2210–2217CrossRefGoogle Scholar
  10. 10.
    Eysel P, Roosen K (1993) [Ventral or dorsal spondylodesis in dens basal fracture–a new classification for choice of surgical approach]. Zentralbl Neurochir 54:159–165PubMedGoogle Scholar
  11. 11.
    Lakshmanan P, Jones A, Howes J, Lyons K (2005) CT evaluation of the pattern of odontoid fractures in the elderly—relationship to upper cervical spine osteoarthritis. Eur Spine J 14:78–83.  https://doi.org/10.1007/s00586-004-0743-z CrossRefPubMedGoogle Scholar
  12. 12.
    Etter C, Coscia M, Jaberg H, Aebi M (1991) Direct anterior fixation of dens fractures with a cannulated screw system. Spine (Phila Pa 1976) 16:S25–S32CrossRefGoogle Scholar
  13. 13.
    Gehweiler JA, Duff DE, Martinez S, Miller MD, Clark WM (1976) Fractures of the atlas vertebra. Skelet Radiol 1:97–102CrossRefGoogle Scholar
  14. 14.
    Owens WD, Felts JA, Spitznagel EL Jr (1978) ASA physical status classifications: a study of consistency of ratings. Anesthesiology 49:239–243CrossRefGoogle Scholar
  15. 15.
    Magerl F, Seeman P (1986) Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, Weidner A (eds) Cervical spine. Springer, Wien, pp 267–278Google Scholar
  16. 16.
    Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochirurgica 129:47–53CrossRefGoogle Scholar
  17. 17.
    Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26:2467–2471CrossRefGoogle Scholar
  18. 18.
    Goel A, Gupta S (1999) Vertebral artery injury with transarticular screws. J Neurosurg 90:376–377PubMedGoogle Scholar
  19. 19.
    Lapsiwala SB, Anderson PA, Oza A, Resnick DK (2006) Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery 58:516–521CrossRefGoogle Scholar
  20. 20.
    Osti M, Philipp H, Meusburger B, Benedetto KP (2011) Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J 20:1915–1920.  https://doi.org/10.1007/s00586-011-1890-7 CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Schoenfeld AJ, Bono CM, Reichmann WM, Warholic N, Wood KB, Losina E, Katz JN, Harris MB (2011) Type II odontoid fractures of the cervical spine: do treatment type and medical comorbidities affect mortality in elderly patients? Spine (Phila Pa 1976) 36:879–885.  https://doi.org/10.1097/BRS.0b013e3181e8e77c CrossRefGoogle Scholar
  22. 22.
    Chapman J, Smith JS, Kopjar B, Vaccaro AR, Arnold P, Shaffrey CI, Fehlings MG (2013) The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976) 38:1098–1104.  https://doi.org/10.1097/BRS.0b013e318286f0cf CrossRefGoogle Scholar
  23. 23.
    Liu JM, Tong WL, Chen XY, Zhou Y, Chen WZ, Huang SH, Liu ZL (2017) The incidences and risk factors related to early dysphagia after anterior cervical spine surgery: a prospective study. PLoS One 12:e0173364.  https://doi.org/10.1371/journal.pone.0173364 CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Puvanesarajah V, Jain A, Shimer AL, Singla A, Shen F, Hassanzadeh H (2017) Complications and mortality following one to two-level anterior cervical fusion for cervical spondylosis in patients above 80 years of age. Spine (Phila Pa 1976) 42:E509–E514.  https://doi.org/10.1097/BRS.0000000000001876 CrossRefGoogle Scholar
  25. 25.
    Tian NF, Hu XQ, Wu LJ, Wu XL, Wu YS, Zhang XL, Wang XY, Chi YL, Mao FM (2014) Pooled analysis of non-union, re-operation, infection, and approach related complications after anterior odontoid screw fixation. PLoS One 9:e103065.  https://doi.org/10.1371/journal.pone.0103065 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Christoph Josten
    • 1
  • Jan-Sven Jarvers
    • 1
  • Stefan Glasmacher
    • 1
  • Ulrich J. Spiegl
    • 1
  1. 1.Department of Orthopaedics, Trauma Surgery and Reconstructive SurgeryUniversity of LeipzigLeipzigGermany

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