9/11/2023 0 Comments Type 3 odontoid fracture![]() However, when present, it can be fatal due to the high level of spinal cord injury. Neurological injury is averted by the relatively larger diameter of the cervical spinal canal at this level. Moradian and Doherty demonstrated in biomechanical studies that type II OFs result from lateral bending and extension forces. The mechanism responsible for odontoid fractures is generally agreed to be hyperflexion or hyperextension of the cervical spine. The aim of this article was to review the literature and summarise the evidence for and against each treatment option for the management of OFs in patients above 65 years.Īlthough fractures of the odontoid occur in all age groups, younger patients often sustain these injuries after motor vehicle accidents while older patients present after low-energy falls and are less likely to have severe neurological deficits. Case reports and review articles were excluded although some were referred to in the discussion. Studies in patients aged greater than 65 years and with follow-up of at least 12 months were included. A Medline search of the English language literature for all published articles on odontoid fractures in the elderly after 1970 was performed. In spite of the relative frequency of odontoid fractures (OF) in the elderly, there is lack of agreement regarding the optimal management especially with type II fractures with no published standards or guidelines to date. Cervical spine fractures in the elderly are potentially life threatening, and it has been reported that following traumatic spinal cord injury, the in-hospital as well as 1-year mortality rates in patients above 65 years is up to eightfold higher. Fracture of the odontoid process of the axis is commonest with majority being Anderson and D’Alonzo type II fractures. Patients in this age group are vulnerable to cervical spine injuries with the upper cervical (C0–C2) spine being involved in more than 50% of the time. In this review, we have arbitrarily considered patients above 65 years as elderly. In most countries, the elderly are the most rapidly growing segment of society, and it is estimated that by 2025, almost a fifth of the population will be over the age of 65. A prospective randomised controlled trial is recommended. While most authors agree that cervical immobilisation yields satisfactory results for type I and III fractures in the elderly, the optimal management for type II fractures remain unsolved. There is insufficient evidence to establish a standard or guideline for odontoid fracture management in elderly. Lately, the posterior cervical (Goel–Harms) construct has also gained popularity amongst surgeons. In recent years several authors have claimed satisfactory results with anterior odontoid screw fixation while others have argued that this may lead to increased complications in this age group. Significant variability was found in the literature regarding mortality and morbidity rates in patients treated with and without halo vest immobilisation. There were two class II studies and the remaining were class III. One-hundred twenty-six articles were reviewed. Studies in patients aged 65 years with a minimum follow-up of 12 months were selected. The search was supplemented by cross-referencing between articles. A search of the English language literature from January 1970 to date was performed using Medline and the following keywords: odontoid, fractures, cervical spine and elderly. The objective of the study was to evaluate the published literature and determine the current evidence for the management of type II odontoid fractures in elderly. The best treatment remains unclear because of the morbidity associated with prolonged cervical immobilisation versus the risks of surgical intervention. There is uncertainty regarding the consequences of non-union. Considerable controversy exists regarding the optimal management of elderly patients with type II odontoid fractures.
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