Geriatric Odontoid Fractures: Treatment Algorithms of the German Society for Orthopaedics and Trauma Based on Expert Consensus and a Systematic Review

Global Spine Journal

卷:13

Special Issue Articles

Georg Osterhoff¹  Matti Scholz²  Alexander C. Disch³  Sebastian Katscher⁴  Ulrich J. A. Spiegl¹  Klaus John Schnake^5,6  Max J. Scheyerer⁷ 

[1] Department of Orthopaedics, Trauma and Plastic Surgery, , Leipzig, Germany

[2] , Braunfels, Germany

[3] Department of Orthopedics and Traumatology, , Nuremberg, Germany

[4] , Borna, Germany

[5] University Comprehensive Spine Center (UCSC), University Center for Orthopaedics, Traumatology & Plastic Surgery, , Germany

[6] Center for Spinal and Scoliosis Surgery, , Erlangen, Germany

[7] Department of Orthopaedics and Trauma Surgery, University of Cologne, , Koln, Germany

关键词: cervical;    odontoid fracture;    treatment;    guidelines;   

DOI  :  10.1177/21925682231157316

来源: Sage Journals

【 摘 要 】

Study DesignSystematic review/expert consensus.ObjectivesFractures of the axis represent the most frequent injury of the spine in elderly patients. Both, operative and non-operative treatment are associated with a high rate of complications and mortality. The aim of this article was to summarize the current literature on the management of odontoid fractures in geriatric patients and to weigh it based on an expert consensus process.MethodsIn a joint consensus process, members of the Spine Section of the German Orthopaedic and Trauma Society (DGOU) aimed to formulate recommendations for the diagnostic workup and treatment of odontoid fractures in geriatric patients. Based on the previously published recommendations, this article is an updated version with incorporating a systematic review of the recent literature.ResultsBased on the new data available, the recommendations established in the initial consensus process were adapted.ConclusionsComputed tomography represents the diagnostic standard for patients with suspected injuries of the upper cervical spine. Anderson/D’Alonzo odontoid fractures type 1, non-displaced type 2, and type 3 can be treated conservatively. Even non-unions do not necessarily result in poor clinical outcome. In Anderson/D’Alonzo type 2 fractures, surgical therapy offers the advantage of relatively safe osseous healing with no increased complication rate even in elderly patients and can thus be recommended. In very high aged patients, however, a case-by-case decision should be made. When surgical stabilization of osteoporotic odontoid fractures is indicated, posterior techniques are biomechanically advantageous and can be considered the standard.

【 授权许可】

CC BY-NC-ND   
© The Author(s) 2023