Cervical spine fractures in the elderly

Cervical spine fractures in the elderly are relatively common. The management of such injuries may be complicated by underlying medical debility and osteopenia as well as reduced tolerance to halo immobilization.

Over a 1-year period, 43 cervical spine fractures were treated at our institution. Ten (23%) were in persons 70 years of age or older. This retrospective analysis describe the clinical features, treatment, and outcome of these 10 elderly patients. All fractures in this patient population involved the atlantoaxial complex, including five combination C1-C2 fractures. Six patients were treated with early halo immobilization and three were initially managed with a rigid cervical collar. Three patients required posterior cervical fusion.

Of the six patients undergoing halo immobilization, five progressed to osseous union. Three patients were immobilized in a Philadelphia collar resulting in one osseous union, one nonunion, and one death. Three patients underwent posterior cervical fusion with subsequent osseous union in all three.

Although external immobilization with a halo device is our treatment of choice for most C1 and C2 fractures in elderly patients, a Philadelphia collar is useful in select cases when halo immobilization or early surgical fusion is contraindicated. Posterior cervical fusion can be safely and effectively performed in elderly patients and should be strongly considered for initial therapy in the elderly with fracture types unlikely to progress to osseous union with external immobilization alone.