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Reliability of treating asymptomatic traumatic type II dens fractures in patients over age 80: A retrospective series.

Momin E, Harsh V, Fridley J, Winnegan L, Omeis I - J Craniovertebr Junction Spine (2015 Oct-Dec)

Bottom Line: At last follow-up, 2 of 5 patients continued to be asymptomatic, the 3(rd) died of unrelated causes while 2 others required surgeries at least 1-year post injury.Independent elderly patients who are asymptomatic at presentation may be safe to be followed up very closely with a neck brace and serial X-ray.Converting to surgical treatment can be done safely when needed without affecting the overall clinical out.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA.

ABSTRACT

Background: Management of type II odontoid fractures in elderly remains controversial to whether surgical treatment is favored over conservative one. This is a study of geriatric patients with asymptomatic type II dens fractures who after sustaining a fall were initially evaluated at community hospitals. They were placed in a rigid collar and were followed up in a spine clinic.

Purpose: To assess the reliability of treating very old patients with type II dens fracture conservatively and whether surgical intervention if needed would affect the clinical outcome.

Study design: Retrospective study with the literature review.

Patient sample: Consecutive patients above 80 years of age, who sustained a clinically asymptomatic type II dens fracture and were observed after a conservative treatment plan, was initiated.

Outcome measures: Outcome measures included self-reported worsening neck pain, neurological function, and radiographic measures over the follow-up period.

Materials and methods: A retrospective clinical analysis of 5 active geriatric patients with type II asymptomatic dens fracture. After evaluating them, treatment options were discussed with patients and their family members. The decision was to continue to follow them with a rigid collar very closely since they were reluctant to undergo any surgical procedure.

Results: Patients were followed for an average of 29 months. They were observed for any worsening neck pain, neurological deficit, or deterioration of fracture on follow-up imaging studies. At last follow-up, 2 of 5 patients continued to be asymptomatic, the 3(rd) died of unrelated causes while 2 others required surgeries at least 1-year post injury.

Conclusions: Treatment of type II dens fractures in the elderly is controversial. Independent elderly patients who are asymptomatic at presentation may be safe to be followed up very closely with a neck brace and serial X-ray. Converting to surgical treatment can be done safely when needed without affecting the overall clinical out.

No MeSH data available.


Related in: MedlinePlus

Patient fell a 2nd time. (a) Sagittal T2-weighted images showing circumferential cord compression. (b) The patient underwent C1 posterior arch resection, bilateral C2 neurectomies, and C1-2 posterior instrumented fusion, with the postoperative result shown in sagittal and anteroposterior X-ray
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Figure 4: Patient fell a 2nd time. (a) Sagittal T2-weighted images showing circumferential cord compression. (b) The patient underwent C1 posterior arch resection, bilateral C2 neurectomies, and C1-2 posterior instrumented fusion, with the postoperative result shown in sagittal and anteroposterior X-ray

Mentions: An 83-year-old male was very active at baseline who initially sustained a fall. He was taken to the emergency room where initial imaging studies were performed [Figure 3]. Nurick scale 2. He was placed in a hard neck brace and was discharged home. Treatment options were discussed with him and surgery was recommended given the nature of the fracture. He declined surgery and sought a second opinion with another spine surgeon who recommended surgery. However, the patient opted not to have surgery and decided to follow-up in our clinic. He was weaned off his brace at 3 months and was followed up closely. He was able to carry on his baseline daily activities until he sustained a second fall 13 months after the first injury. He presented to clinic ambulating, however, with worsening neck and occipital pain. Repeat imaging of his cervical spine including an MRI showed worsening of the fracture with circumferential cord compression. He eventually agreed to surgery and underwent C1 posterior arch resection, bilateral C2 neurectomies, and C1-2 posterior instrumented fusion. The hospital course was uneventful and he was discharged home [Figure 4].


Reliability of treating asymptomatic traumatic type II dens fractures in patients over age 80: A retrospective series.

Momin E, Harsh V, Fridley J, Winnegan L, Omeis I - J Craniovertebr Junction Spine (2015 Oct-Dec)

Patient fell a 2nd time. (a) Sagittal T2-weighted images showing circumferential cord compression. (b) The patient underwent C1 posterior arch resection, bilateral C2 neurectomies, and C1-2 posterior instrumented fusion, with the postoperative result shown in sagittal and anteroposterior X-ray
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660492&req=5

Figure 4: Patient fell a 2nd time. (a) Sagittal T2-weighted images showing circumferential cord compression. (b) The patient underwent C1 posterior arch resection, bilateral C2 neurectomies, and C1-2 posterior instrumented fusion, with the postoperative result shown in sagittal and anteroposterior X-ray
Mentions: An 83-year-old male was very active at baseline who initially sustained a fall. He was taken to the emergency room where initial imaging studies were performed [Figure 3]. Nurick scale 2. He was placed in a hard neck brace and was discharged home. Treatment options were discussed with him and surgery was recommended given the nature of the fracture. He declined surgery and sought a second opinion with another spine surgeon who recommended surgery. However, the patient opted not to have surgery and decided to follow-up in our clinic. He was weaned off his brace at 3 months and was followed up closely. He was able to carry on his baseline daily activities until he sustained a second fall 13 months after the first injury. He presented to clinic ambulating, however, with worsening neck and occipital pain. Repeat imaging of his cervical spine including an MRI showed worsening of the fracture with circumferential cord compression. He eventually agreed to surgery and underwent C1 posterior arch resection, bilateral C2 neurectomies, and C1-2 posterior instrumented fusion. The hospital course was uneventful and he was discharged home [Figure 4].

Bottom Line: At last follow-up, 2 of 5 patients continued to be asymptomatic, the 3(rd) died of unrelated causes while 2 others required surgeries at least 1-year post injury.Independent elderly patients who are asymptomatic at presentation may be safe to be followed up very closely with a neck brace and serial X-ray.Converting to surgical treatment can be done safely when needed without affecting the overall clinical out.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA.

ABSTRACT

Background: Management of type II odontoid fractures in elderly remains controversial to whether surgical treatment is favored over conservative one. This is a study of geriatric patients with asymptomatic type II dens fractures who after sustaining a fall were initially evaluated at community hospitals. They were placed in a rigid collar and were followed up in a spine clinic.

Purpose: To assess the reliability of treating very old patients with type II dens fracture conservatively and whether surgical intervention if needed would affect the clinical outcome.

Study design: Retrospective study with the literature review.

Patient sample: Consecutive patients above 80 years of age, who sustained a clinically asymptomatic type II dens fracture and were observed after a conservative treatment plan, was initiated.

Outcome measures: Outcome measures included self-reported worsening neck pain, neurological function, and radiographic measures over the follow-up period.

Materials and methods: A retrospective clinical analysis of 5 active geriatric patients with type II asymptomatic dens fracture. After evaluating them, treatment options were discussed with patients and their family members. The decision was to continue to follow them with a rigid collar very closely since they were reluctant to undergo any surgical procedure.

Results: Patients were followed for an average of 29 months. They were observed for any worsening neck pain, neurological deficit, or deterioration of fracture on follow-up imaging studies. At last follow-up, 2 of 5 patients continued to be asymptomatic, the 3(rd) died of unrelated causes while 2 others required surgeries at least 1-year post injury.

Conclusions: Treatment of type II dens fractures in the elderly is controversial. Independent elderly patients who are asymptomatic at presentation may be safe to be followed up very closely with a neck brace and serial X-ray. Converting to surgical treatment can be done safely when needed without affecting the overall clinical out.

No MeSH data available.


Related in: MedlinePlus