Clinical evaluation of anterior screw fixation for elderly patients with type II odontoid fractures

A retrospective study of elderly patients who underwent anterior screw fixation for type II odontoid fractures between 2000 and 2009 was conducted.

To evaluate the clinical outcome of anterior screw fixation for type II odontoid fractures in elderly people and to provide valuable information for spinal surgeon reference.

Odontoid fractures are the most common fractures of the cervical spine in patients above 70 years of age, and patients above 80 years of age form the majority of spinal fractures. However, the optimum treatment of type II odontoid fractures in the geriatric population remains controversial.

A retrospective analysis was performed in 43 patients (19 women; mean age, 80.6 y; range, 65 to 92 y) with type II odontoid fractures who were consecutively admitted to a single medical center between January 2000 and October 2009. Twenty-eight patients had posteriorly displaced odontoid fractures and the remaining 15 had anteriorly displaced odontoid fractures according to the radiographical presentation. Neurological symptoms were present in 4 patients including 3 Frankel D and 1 Frankel C and always occurred in patients with posteriorly displaced odontoid process. The medical records, plain x-rays, and computed tomographic scans of all patients were reviewed. After surgery, patients were discharged with rigid cervical immobilization and clinical follow-ups were between 18 and 24 months (average, 21.3 mo).

The mean displacement of odontoid process revealed by preoperative radiologic evaluation was 4.9 mm (ranged from 1 to 10 mm). Anterior screw fixation was performed successfully in 42 cases except 1 in which posterior C1-C2 fusion had to be undertaken to replace the original operation scheme because of technical difficulty. According to postoperative radiologic evaluation, 36 of 42 type II odontoid fracture cases treated with anterior screw fixation achieved fusion within 6 months. The fusion rate was 85.7% (36 of 42). Thirty-four patients regained normal cervical movement, 5 patients had about 25%, and 3 had >25% limited cervical motion. Sixteen patients achieved clinically excellent outcomes, 24 good, and 2 fair outcomes.

Anterior screw fixation can be performed safely in elderly patients with type II odontoid fracture, and the clinical outcomes of this procedure were satisfactory. High fusion rates, low postoperative complications, and maintenance of cervical motion were acquired. The anterior screw fixation can be a reliable and reasonable treatment for type II odontoid fractures in the elderly patients.