Anterior fixation of odontoid fractures in an elderly population

Update item information
Publication Type Journal Article
School or College School of Medicine
Department Neurosurgery
Creator Dailey, Andrew T.; Schmidt, Meic H.; Apfelbaum, Ronald I.
Other Author Hart, David; Finn, Michael A.
Title Anterior fixation of odontoid fractures in an elderly population
Date 2010
Description Object. Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods. A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results. Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions. Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.
Type Text
Publisher American Association of Neurological Surgeons (AANS)
Volume 12
Issue 1
First Page 1
Last Page 8
Subject Odontoid fractures; Elderly population; Anterior fixation
Subject LCSH Fracture fixation; Cervical vertebrae -- Wounds and injuries; Cervical vertebrae -- Fractures; Fractures in old age
Language eng
Bibliographic Citation Dailey, A. T., Hart, D., Finn, M. A., Schmidt, M. H., & Apfelbaum, R. I. (2010). Anterior fixation of odontoid fractures in the aging population. Journal of Neurosurgery: Spine, 12(1), 1-8.
Rights Management (c) American Association of Neurological Surgeons
Format Medium application/pdf
Format Extent 484,658 bytes
Identifier ir-main,13305
ARK ark:/87278/s6dn4ppj
Setname ir_uspace
Date Created 2012-06-13
Date Modified 2021-05-06
ID 706769
Reference URL