Anterior screw fixation of odontoid fractures comparing younger and elderly patients

A retrospective, comparative study.

Anterior screw fixation has become an accomplished treatment option for the management of odontoid fractures. In younger patients, it has shown encouraging results with low complication rates; whereas in geriatric trauma victims, it remains the subject of controversy. The purpose of this study was to determine functional and radiographic results after anterior screw fixation of Type II odontoid fractures, with the particular interest to compare the outcome between younger and elderly patients.

We reviewed clinical and radiographic records of 110 patients with an average age of 54 years at the time of surgery after anterior double screw fixation of their odontoid fractures between 1990 and 2004. To compare functional and radiographic results between nongeriatric and geriatric patients, they were divided by age into 2 groups: Group A included patients 65 years of age or younger and Group B contained patients older than 65 years.

A total of 95 patients had returned to their preinjury activity level and were satisfied with their treatment. The Smiley-Webster scale showed an overall outcome score of 1.42 with similar results in both groups (Group A, 1.34; Group B, 1.50). Bony fusion was achieved in 102 patients, failures of reduction or fixation occurred in 12 patients. Comparing between the 2 groups, we had a nonunion rate of 4% in younger individuals and a significantly higher rate of 12% in geriatric patients. Reoperation due to nonunion or technical failures was necessary in 8 patients.

We had encouraging results using anterior screw fixation for surgical treatment of odontoid fractures and favor this method as preferred management strategy for stabilization of these fractures. Comparing between age groups, we had similar results on cervical spine function. With regards to fracture healing as well as morbidity and mortality, younger patients had a superior outcome.