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Bhushan A, Beland A, Poelstra C, Butterfield J, Angel M, Cheung T, Plater E, Guha D, Pahuta M, Macedo LG. Immobilization protocols for the treatment of cervical spine fracture: a scoping review. Spine J 2024:S1529-9430(24)00264-X. [PMID: 38908439 DOI: 10.1016/j.spinee.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND Current protocols on cervical immobilization postcervical spine fracture are widely accepted in the acute rehabilitation of older adults, however consensus on its overall effectiveness remains lacking. PURPOSE Summarize information from original studies on available cervical immobilization protocols following a cervical fracture and to answer the questions; Which types of study designs have been used to assess the effectiveness of these protocols? What are the currently reported cervical immobilization protocols following cervical fracture in adults? What is the effectiveness of these protocols? What adverse events are associated with these protocols? STUDY DESIGN Scoping review was performed. PATIENT SAMPLE Searches were performed on the following online databases from inception to February 23, 2023: EMBASE, MEDLINE, CINAHL, and CENTRAL. Databases were searched for articles pertaining to collar use post cervical spine fracture. OUTCOME MEASURES Effectiveness of the cervical fracture immobilization protocols was the primary outcome, examined by various measures including union rates and disability indexes. METHODS 4 databases were searched; EMBASE, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) beginning on February 23, 2023, where 5,127 studies were yielded and 32 were extracted based on studies of adults (≥18 years) with a diagnosis of a cervical fracture (C0-C7) managed with a rigid external orthosis to prevent instability and surgery (collar, or cervicothoracic orthosis). Risk of bias was assessed using the guidelines set out by the Joanna Briggs Institute. RESULTS This scoping review yielded low-level prospective (18%) and retrospective (69%) cohort studies, case-control studies (3%), and case series (6%) from 1987 to 2022, patient age ranged from 14 to 104 years. Findings were difficult to summarize based on the lack of randomized controlled trials, leading to no clear conclusions drawn on the presence of standardized cervical immobilization protocols with no information on the duration of treatment or transition in care. Most included articles were retrospective cohort studies of poor to moderate quality, which have significant risk of bias for intervention questions. The effectiveness of these protocols remains unclear as most studies evaluated heterogeneous outcomes and did not present between-group differences. Mortality, musculoskeletal (MSK) complications, and delayed surgery were common adverse events associated with cervical collar use. CONCLUSION This scoping review highlights the need for higher levels of evidence as there is currently no standardized immobilization protocol for cervical spine fractures as a primary treatment, the effectiveness of cervical immobilization protocols is unclear, and mortality, MSK complications, and delayed surgery are common adverse events. No sources of funding were used for this scoping review.
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Affiliation(s)
- Akhilesh Bhushan
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexa Beland
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Chantelle Poelstra
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Butterfield
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Marina Angel
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Tiffany Cheung
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Emma Plater
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada
| | - Daipayan Guha
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Markian Pahuta
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Luciana G Macedo
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, Ontario, Canada.
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Kerschbaum M, Klute L, Henssler L, Rupp M, Alt V, Lang S. Risk factors for in-hospital mortality in geriatric patients aged 80 and older with axis fractures: a nationwide, cross-sectional analysis of concomitant injuries, comorbidities, and treatment strategies in 10,077 cases. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:185-197. [PMID: 37714928 DOI: 10.1007/s00586-023-07919-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/05/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023]
Abstract
PURPOSE To investigate the association between treatment, comorbidities, concomitant injuries, and procedures with in-hospital mortality in patients aged 80 years or older with axis fractures. METHODS Data were extracted from the German InEK (Institut für das Entgeltsystem im Krankenhaus) GmbH database (2019-2021) for patients aged 80 years or older with axis fractures and the in-hospital mortality rate was calculated. Differences in comorbidities and concomitant diseases and injuries were analyzed using the Chi-square test. In surgically treated patients, odds ratios (OR) with 95% confidence intervals (95% CI) were used to analyze potential risk factors for in-hospital mortality. RESULTS Among 10,077 patients, the in-hospital mortality rate was 8.4%, with no significant difference between surgically (9.4%) and non-surgically treated patients (7.9%; p = 0.103). The most common comorbidities were essential hypertension (67.3%), atrial fibrillation (28.2%), and chronic kidney disease (23.3%), while the most common concomitant injuries were head and face wounds (25.9%), concussions (12.8%), and atlas fractures (11.6%). In surgically treated patients, spinal cord injury (OR = 4.62, 95% CI: 2.23-9.58), acute renal failure (OR = 3.20, 95% CI: 2.26-4.53), and acute bleeding anemia (OR = 2.06, 95% CI: 1.64-2.59) were associated with increased in-hospital mortality (all p < 0.01). Screw-rod-system fixation of one segment (OR = 0.74, 95% CI: 0.56-0.97) and intraoperative navigation (OR = 0.45, 95% CI: 0.16-0.71) were identified as potential protective factors (both p < 0.05). CONCLUSION Comprehensive geriatric assessment and optimization of comorbidities during treatment are crucial. The indication for surgical treatment must be carefully individualized. Future studies should focus on the choice of surgical technique, perioperative blood management, and intraoperative navigation as potential protective factors.
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Affiliation(s)
- Maximilian Kerschbaum
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lisa Klute
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Leopold Henssler
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Siegmund Lang
- Department of Trauma Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Brannigan JF, Dohle E, Critchley GR, Trivedi R, Laing RJ, Davies BM. Adverse Events Relating to Prolonged Hard Collar Immobilisation: A Systematic Review and Meta-Analysis. Global Spine J 2022; 12:1968-1978. [PMID: 35333123 PMCID: PMC9609519 DOI: 10.1177/21925682221087194] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar. METHODS Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted. Two reviewers independently screened the search results according to pre-determined search criteria. Data was extracted and tabulated. Joanna Briggs Institute checklists were used for assessing the quality of included studies. RESULTS The search identified 773 articles. A total of 25 studies were selected for final inclusion. The results largely comprised a mixture of case reports/series, cohort studies and reviews. The most commonly reported complications were pressure ulcers, dysphagia and increased intracranial pressure. A pressure ulcer pooled prevalence of 7% was calculated. There was insufficient data for quantitative analysis of any other complication. CONCLUSIONS There is significant morbidity from prolonged hard collar immobilisation, even amongst younger patients. Whilst based upon limited and low-quality evidence, these findings, combined with the low-quality evidence for the efficacy of hard collars, highlights a knowledge gap for future research.
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Affiliation(s)
- Jamie F.M. Brannigan
- Division of Neurosurgery,
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,School of Clinical Medicine, University of Cambridge, Cambridge, UK,Jamie F.M. Brannigan BA, Division of
Neurosurgery, Department of Clinical Neurosciences, University of Cambridge,
Jesus College, Cambridge CB5 8BL, UK.
| | - Esmee Dohle
- Division of Neurosurgery,
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Giles R. Critchley
- Department of Neurosurgery, Brighton and Sussex University
Hospitals National Health Service Trust, Brighton, UK
| | - Rikin Trivedi
- Division of Neurosurgery,
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Rodney J. Laing
- Division of Neurosurgery,
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Benjamin M. Davies
- Division of Neurosurgery,
Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK,Myelopathy.org, University of Cambridge, UK
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Carneiro-Filho GDS, de Macêdo LP, Andrade LI, Alves-Sá BF, Sousa LAM, de Medeiros Quirino SC, Chaves JR, Bezerra-Júnior DL, Almeida NS, Azevedo-Filho HRC. Upper Cervical Spine Injuries: Profile and Management of 120 Cases. Int J Spine Surg 2022; 16:1001-1008. [PMID: 35831063 PMCID: PMC9807045 DOI: 10.14444/8321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To identify the profile and management of patients with upper cervical spine injury. METHODS Retrospective cohort study of patients with upper cervical spine injuries managed at Hospital da Restauração between 2014 and 2020. RESULTS It presents the profile of 145 injuries recorded by location and classification among the 120 patients, and the management performed. Men are more affected than women, almost half of the patients (42.5%) were aged 16 to 29 years. Neurological deficit was present in 18 cases (15%). Twenty cases presented injury involving the level C1. Most injuries (109 [90.8%]) occurred at the C2 level, the most frequent of which were as follows: isolated type II odontoid fracture (29.2%), miscellaneous fracture of C2 (20%), and isolated hangman's fracture (13.3%). The most used management in type II odontoid fracture was C1-C2 posterior arthrodesis (17/42) followed by odontoid osteosynthesis (12/42). Regarding isolated hangman's fracture, conservative management was performed in 37.5% (6/16), and the technical approach most performed was anterior C2-C3 discectomy and interbody fusion (5/16). CONCLUSIONS Upper cervical spine injury has a higher prevalence in young men and is most often caused by traffic accidents. The main level affected is C2, and type II odontoid fracture is the most frequent subtype. C1 injury is related to conservative treatment, while C2 or combined C1-C2 injury is related to surgical approach. The management of these injuries is mainly performed with surgical treatment, with C1-C2 posterior arthrodesis and anterior odontoid osteosynthesis representing most of the approaches.
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Affiliation(s)
| | - Lívio Pereira de Macêdo
- Hospital da Restauração, Recife, Pernambuco, Brazil, Lívio Pereira de Macêdo, Hospital da Restauração Recife, Rua João Fernandes Vieira, 544, Boa Vista, Recife, PE, Brazil;
| | | | | | | | | | | | | | - Nivaldo S. Almeida
- Department of Neurosurgery, Hospital da Restauração, Recife, Pernambuco, Brazil
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Kumar S, Jain A, Tawari M, Rathore L, Sahana D, Mishra H, Sahu R. An experience with Goel-Harms C1-C2 fixation for type II odontoid fractures. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:175-181. [PMID: 35837432 PMCID: PMC9274684 DOI: 10.4103/jcvjs.jcvjs_22_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/14/2022] [Indexed: 11/04/2022] Open
Abstract
Objective: Type II odontoid fractures need surgical stabilization for disabling neck pain and instability. Anterior odontoid screw fixation is a well-known technique. However, certain patients require posterior fixation. We present our surgical results and experiences with nine cases managed by the Goel-Harms technique. Materials and Methods: This is a retrospective review of nine patients operated on between January 2019 and December 2021 for Type II odontoid fractures with posterior fixation technique. Their clinical profile was collected from case files. The radiological data were retrieved from radiology archives. The indications for surgery were instability and refractory neck pain. The surgical decision for posterior fixation was guided by fracture morphology. Results: The mean age of presentation was 37.22 ± 9.85 years. Seven patients had Type II, and two had Type IIa odontoid fracture. All patients presented with unbearable neck pain. One patient had a quadriparesis. The fracture line was anterior-inferior sloping in six, posterior-inferior sloping in two, and transverse in one case. The anterior-posterior displacement of fracture ranged from 0 to 7 mm (mean 2.44 ± 2.18 mm). Partial transverse ligament tear without the Atlanto Axial Dislocation was present in three patients. The C1-C2 joint distraction was required in five cases. C1-C2 joint spacer was required in two cases. Following surgery, neck pain was relieved in all cases. Complete fracture alignment was achieved in eight patients. There were no postoperative complications. At the mean follow-up of 16.22 ± 9.61 months, there was no implant failure. Conclusions: Posterior C1-C2 fixation by the Goel-Harms technique is an excellent alternative to anterior fixation in selected cases.
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Rizvi SAM, Helseth E, Harr ME, Mirzamohammadi J, Rønning P, Mejlænder-Evjensvold M, Linnerud H. Management and long-term outcome of type II acute odontoid fractures: a population-based consecutive series of 282 patients. Spine J 2021; 21:627-637. [PMID: 33346157 DOI: 10.1016/j.spinee.2020.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The surgical fixation rate of type II odontoid fracture (OFx) in the elderly (≥65 years) is much lower than expected if the treatment adheres to current general treatment recommendations. Outcome data after conservative treatment for elderly patients with these fractures are sparse. PURPOSE The main aim of this study was to determine the long-term outcome after conservative and surgical treatments of type II OFx (all age-groups) to evaluate whether nonoperative treatment yields an acceptable outcome. STUDY DESIGN/SETTING Retrospective study based on a prospective database. PATIENT SAMPLE Two hundred eighty-two consecutive patients with type II OFx treated at Oslo University Hospital over an 8-year period. OUTCOME MEASURES Long-term rates of bony fusion, fibrous union, pseudarthrosis, crossover from primary conservative treatment to surgical fixation, new-onset spinal cord injury (SCI), and neck pain were the outcome measures used. METHODS The present study was based on data extracted from our quality control database for acute cervical spine fractures. All ages were included. In addition, long-term follow-up of alive patients was performed during the years 2018-2019. The follow-up included neurological examination, radiological examination, and scoring of bony fusion status, crossover from primary conservative treatment to surgical fixation, new-onset SCI, neck pain, and Neck Disability Index (NDI score). Data are described by counts, percentages, medians, means, ranges and standard deviations where appropriate. For statistical analyses the Mann-Whitney U test, Wilcoxon signed-rank test, and t tests were used. RESULTS During the eight-year study period, we registered 282 consecutive patients with type II OFx; 54% were males, patient age ranged from 15 to 101 years, 84% were ≥65 years of age (WHO definition of elderly), and 51% were ≥80 years of age. Severe comorbidities (American Society of Anesthesiologists, ASA ≥3) were seen in 67%, whereas nonindependent living was registered in 32%. Severe comorbidities and nonindependent living were significantly associated with increasing age (p<.001). SCI secondary to the OFx was seen in 5.3%. Primary treatment of the OFx was conservative (external immobilization alone) in 193 patients (68.4%), open surgical fixation in 87 patients (30.9%), and no treatment in two critically injured patients. At the time of long-term follow-up, 125 patients had died, nine patients declined the invitation to follow-up, and five patients did not respond. Thus, 143 patients were available for follow-up with a median follow-up time of 39 months (range 5-115 months). At long-term follow-up, the fusion status was bony fusion in 39.2% of patients, fibrous union in 57.3%, and pseudarthrosis in 3.5%. The proportion of bony fusion was significantly higher in the primary surgical fixation group (p=.005). No patients had new-onset SCI presenting after the start of primary treatment. The proportion of crossover from primary external immobilization to surgery was 14.4%, whereas proportion of revision surgery in the primary surgical group was 9.5%. There was no significant difference between the primary surgical fixation group and the primary conservative treatment group at long-term follow-up with respect to the proportion of pseudarthrosis and degree of neck pain. CONCLUSIONS Primary conservative treatment of elderly patients with type II OFx appears to be safe and should be regarded a viable treatment option.
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Affiliation(s)
- Syed Ali Mujtaba Rizvi
- Faculty of Medicine, University of Oslo, Postboks 1078 Blindern, Oslo, 0316 Norway; Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway.
| | - Eirik Helseth
- Faculty of Medicine, University of Oslo, Postboks 1078 Blindern, Oslo, 0316 Norway; Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Marianne Efskind Harr
- Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Jalal Mirzamohammadi
- Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Pål Rønning
- Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | | | - Hege Linnerud
- Department of Neurosurgery, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
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Cleland J, Hutchinson C, Khadka J, Milte R, Ratcliffe J. A Review of the Development and Application of Generic Preference-Based Instruments with the Older Population. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:781-801. [PMID: 31512086 DOI: 10.1007/s40258-019-00512-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Older people (aged 65 years and over) are the fastest growing age cohort in the majority of developed countries, and the proportion of individuals defined as the oldest old (aged 80 years and over) living with physical frailty and cognitive impairment is rising. These population changes put increasing pressure on health and aged care services, thus it is important to assess the cost effectiveness of interventions targeted for older people across health and aged care sectors to identify interventions with the strongest capacity to enhance older peoples' quality of life and provide value for money. Cost-utility analysis (CUA) is a form of economic evaluation that typically uses preference-based instruments to measure and value health-related quality of life for the calculation of quality-adjusted life-years (QALYS) to enable comparisons of the cost effectiveness of different interventions. A variety of generic preference-based instruments have been used to measure older people's quality of life, including the Adult Social Care Outcomes Toolkit (ASCOT); Health Utility Index Mark 2 (HUI2); Health Utility Index Mark 3 (HUI3); Short-Form-6 Dimensions (SF-6D); Assessment of Quality of Life-6 dimensions (AQoL-6D); Assessment of Quality of Life-8 dimensions (AQoL-8D); Quality of Wellbeing Scale-Self-Administered (QWB-SA); 15 Dimensions (15D); EuroQol-5 dimensions (EQ-5D); and an older person specific preference-based instrument-the Investigating Choice Experiments Capability Measure for older people (ICECAP-O). This article reviews the development and application of these instruments within the older population and discusses the issues surrounding their use with this population. Areas for further research relating to the development and application of generic preference-based instruments with populations of older people are also highlighted.
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Affiliation(s)
- Jenny Cleland
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Claire Hutchinson
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
- Healthy Ageing Research Consortium, Registry of Older South Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Rachel Milte
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Sciences, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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TO THE EDITOR. Spine (Phila Pa 1976) 2019; 44:E927. [PMID: 31335791 DOI: 10.1097/brs.0000000000003105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Azad TD, Jiang B, Zhu AM, Theodore N. Healing of type II odontoid fracture without surgery in an octogenarian - Case report and literature review. J Clin Neurosci 2019; 64:23-24. [PMID: 30940454 DOI: 10.1016/j.jocn.2019.03.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 11/26/2022]
Abstract
Odontoid fractures are the most common cervical spine fracture in the elderly. There is considerable controversy regarding the optimal management of type II odontoid fractures in this population. We present the case of an 89-year-old woman presented with neck pain after a mechanical fall. She was neurologically intact. Computed tomography (CT) of the cervical spine revealed a Type II odontoid fracture with 4.4 mm of posterior displacement. Given the patient's extensive medical comorbidities, non-operative management with a rigid cervical orthosis was elected. The patient underwent serial imaging and routine clinical follow up. CT scan at one-year follow-up demonstrated complete osseous union. The patient's neck pain resolved and her cervical collar was discontinued. The risk benefit profile for surgical intervention in elderly patients with Type II odontoid fractures must be weighed against the morbidity associated with prolonged cervical immobilization. This case highlights the importance of serial surveillance imaging and demonstrates that complete arthrodesis can be achieved even in the elderly with prolonged cervical immobilization alone.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Bowen Jiang
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Alex M Zhu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Nicholas Theodore
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, MD, United States.
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