Die Wirbelsäule 2023; 07(01): 47-49
DOI: 10.1055/a-1964-6848
Übersicht

Operative Versorgung der Typ 2 Dens Fraktur bei >80j – Synthese

Surgical treatment of type 2 dens fractures in patients >80 years – synthesis
Klaus John Schnake
1   Interdisziplinäres Zentrum für Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St. Marien, Erlangen, Deutschland
› Institutsangaben

Zusammenfassung

Typ 2 Dens axis Frakturen bei Patienten über 80 Jahre können erfolgreich konservativ oder operativ behandelt werden. Komorbiditäten bzw. die Gebrechlichkeit der Patienten sind mit entscheidend für die Mortalität und das klinische Ergebnis. Dislozierte Frakturen sollten bevorzugt einer operativen Therapie unterzogen werden. Sehr hochbetagte Patienten profitieren eher nicht von einer operativen Therapie.

Abstract

Type 2 dens axis fractures in patients above the age of 80 can be treated successfully with both surgical and non-surgical treatment. Comorbidities and frailty are important factors for mortality and outcome. Dislocated fractures should preferably be treated surgically. However, patients well advanced in years do not benefit from surgery.



Publikationsverlauf

Artikel online veröffentlicht:
27. Februar 2023

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  • Literatur

  • 1 Ryan MD, Henderson JJ. The epidemiology of fractures and fracture dislocations of the cervical spine. Injury 1992; 23: 38-40
  • 2 Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974; 56: 1663-1674
  • 3 Grauer JN, Shafi B, Hilibrand AS. et al. Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J 2005; 5: 123-129
  • 4 Heggeness MH, Doherty BJ. The trabecular anatomy of the axis. Spine (Phila Pa 1976) 1993; 18: 1945-1949
  • 5 Sasso RC. C2 dens fractures: treatment options. J Spinal Disord 2001; 14: 455-463
  • 6 Evaniew N, Yarascavitch B, Madden K. et al. Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality. Spine J 2015; 15: 910-917
  • 7 Venkatesan M, Northover JR, Wild JB. et al. Survival analysis of elderly patients with a fracture of the odontoid peg. Bone Joint J 2014; 96: 88-93
  • 8 Chapman J, Smith JS, Kopjar B. et al. The AOSpine North America Geriat- ric Odontoid Fracture Mortality Study: a retrospective review of mortal- ity outcomes for operative versus nonoperative treatment of 322 pa- tients with long-term follow-up. Spine (Phila Pa 1976) 2013; 38: 1098-1104 DOI: 10.1097/BRS.0b013e318286f0cf.
  • 9 Vaccaro AR, Kepler CK, Kopjar B. et al. Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture. J Bone Joint Surg Am 2013; 95: 729-735 DOI: 10.2106/JBJS.K.01636.
  • 10 Nourbakhsh A, Shi R, Vannemreddy P. et al. Operative versus nonoperative management of acute odontoid Type II fractures: a meta-analysis. J Neurosurg Spine 2009; 11: 651-658 DOI: 10.3171/2009.7.SPINE0991.
  • 11 Smith S, Somogyi R, Lin C. et al. Surgical management of type II displaced dens fractures improves one-year mortality in elderly patients. Spine (Phila Pa 1976) 2022; 47: 1157-1164 DOI: 10.1097/BRS.0000000000004383.
  • 12 Robinson AL, Olerud C, Robinson Y. Surgical treatment improves survival of elderly with axis fracture-a national population-based multiregistry cohort study. Spine J 2018; 18: 1853-1860 DOI: 10.1016/j.spinee.2018.03.021..
  • 13 Deng H, Yue JK, Upadhyayula PS. et al. Odontoid fractures in the octogenarian: a systematic review and meta-analysis. Review J Neurosurg Sci 2016; 60: 543-55
  • 14 Carlstrom LP, Helal A, Perry A. et al. Too frail is to fail: Frailty portends poor outcomes in the elderly with type II odontoid fractures independent of management strategy. J Clin Neurosci 2021; 93: 48-53 DOI: 10.1016/j.jocn.2021.08.027..
  • 15 Borsotti F, Starnoni D, Ecker T. et al. One-year follow-up for type II odontoid process fractures in octogenarians: Is there a place for surgical management?. Surg Neurol Int 2020; 11: 285 DOI: 10.25259/SNI_376_2020..
  • 16 Chibbaro S, Mallereau CH, Ganau M. et al. Odontoid Type II fractures in elderly: what are the real management goals and how to best achieve them? A multicenter European study on functional outcome. Multicenter Study Neurosurg Rev 2022; 45: 709-718 DOI: 10.1007/s10143-021-01594-2..
  • 17 Graffeo CS, Perry A, Puffer RC. et al. Deadly falls: operative versus nonoperative management of Type II odontoid process fracture in octogenarians. J Neurosurg Spine 2017; 26: 4-9 DOI: 10.3171/2016.3.SPINE151202..
  • 18 Perry A, Graffeo CS, Carlstrom LP. et al. Fusion, Failure, Fatality: Long-term Outcomes After Surgical Versus Nonoperative Management of Type II Odontoid Fracture in Octogenarians. Comparative Study World Neurosurg 2018; 110: e484-e489 DOI: 10.1016/j.wneu.2017.11.020..
  • 19 Ishak B, Schneider T, Gimmy V. et al. Early Complications, Morbidity, and Mortality in Octogenarians and Nonagenarians Undergoing Posterior Intra-Operative Spinal Navigation-Based C1/2 Fusion for Type II Odontoid Process Fractures. J Neurotrauma 2017; 34: 3326-3335 DOI: 10.1089/neu.2017.4968..
  • 20 Gembruch O, Lemonas E, Ahmadipour Y. et al. Treatment of Odontoid Type II Fractures in Octogenarians: Balancing Two Different Treatment Strategies. Neurospine 2019; 16: 360-367 DOI: 10.14245/ns.1836250.125..
  • 21 Dhall SS, Yue JK, Winkler EA. et al. Morbidity and Mortality Associated with Surgery of Traumatic C2 Fractures in Octogenarians. Neurosurgery 2017; 80: 854-862 DOI: 10.1093/neuros/nyw168..
  • 22 Joestl J, Lang N, Bukaty A. et al. A comparison of anterior screw fixation and halo immobilisation of type II odontoid fractures in elderly patients at increased risk from anaesthesia. Bone Joint J 2016; 98-B: 1222-1226
  • 23 Shafafy R, Valsamis EM, Luck J. et al. Predictors of mortality in the elderly patient with a fracture of the odontoid process. Multicenter Study. Bone Joint J 2019; 101-B: 253-259 DOI: 10.1302/0301-620X.101B3.BJJ-2018-1004.R1.
  • 24 von Glinski A, Frieler S, Elia C. et al. Risk factors associated with 90-day readmissions following odontoid fractures: A nationwide readmissions database study. Spine (Phila Pa 1976) 2021; 46: 1039-1047 DOI: 10.1097/BRS.0000000000004010..
  • 25 Osterhoff G, Schnake K, Scheyerer MJ. et al. Empfehlungen zu Diagnostik und Behandlung von Frakturen des Dens axis bei geriatrischen Patienten. Z Orthop Unfall 2020; 158: 647-656 DOI: 10.1055/a-0989-2791..