Operative Versorgung der Typ2-Densfraktur bei >80 Jahren – Contra

Zusammenfassung

Die Versorgung der Typ 2-Densfraktur bei alten PatientInnen wird anhaltend intensiv diskutiert und die Studienlage ist uneinheitlich. Bei weniger alten PatientInnen und bei Frakturen mit ausgeprägter Dislokation oder neurologischen Defiziten wird eine operative Therapie mittels dorsaler HWK 1/2-Instrumentation empfohlen. Die große Mehrzahl der PatientInnen jedoch zeigt nach konservativer Therapie mit einer semirigiden Orthese für 12 Wochen ein klinisch hervorragendes Ergebnis und das Auftreten neuer neurologischer Defizite ist eine Rarität. Die Reoperationsrate nach primär chirurgischer Versorgung ist vergleichbar zur Notwendigkeit einer sekundären Operation aufgrund eines Versagens der konservativen Therapie. Auch wenn ohne Instrumentation nur in ca. 40% der Fälle eine knöcherne Fusion eintritt, korreliert eine Pseudoarthrose nicht mit Beschwerden.

Abstract

The management of odontoid fractures in the elderly is an ongoing matter of debate and evidence is contradictory. Patients less than 80 years old, those with neurologic deficits and significantly dislocated fractures are recommended to undergo surgery by posterior C1/C2 instrumentation and fusion. The vast majority of patients, however, demonstrate an excellent outcome with conservative management by semirigid orthosis for 12 weeks. Secondarily developing neurologic deficits are exceedingly rare. Reoperation rates after primary surgery are comparable to rates of surgery after failure of conservative care. Although fusion rates without instrumentation are only approximately 40%, pseudarthrosis is not associated with clinical symptoms.

Schlüsselwörter

Operative Therapie - konservative Therapie - Densfraktur - geriatrisch - Outcome - Komplikationen

Keywords

Surgery - conservative treatment - odontoid fracture - elderly - outcome - complications

Publication History

Article published online:
27 February 2023

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