Staff Members - Benha University
Modified anterior transarticular C1/2 fixation for odontoid fractures:An approach with high complication rate in geriatric population
• 2022
Publication Information
Authors
Mourad MA. 2 ,Ottenbacher A.1, Rizk AR.
Keywords
Not Available
Journal
Not Available
Publisher
Not Available
Volume
Not Available
Issue
Not Available
Pages
Not Available
publication.type
Local
Paper Link
Not Available
Supplementary Materials
Not Available
Abstract
Abstract
Introduction: In patients over 75 years of age, we applied a modified anterior transarticular C1/2 fixation with reduced pharyngeal mobilization vs. the standard anterior triple/quadruple osteosynthesis procedures.
Material/Methods: From 2010 - 2018, 29 patients underwent a modified anterior transarticular C1/2 fixation utilizing single odontoid screw fixation via a right-sided Smith-Robinson- (i.e. short and steep screw trajectory for the right and long trajectory for the left side) approach. All the patients were 75 years of age or older (mean age 82.6), and had sustained odontoid type II fractures. Additionally, asubset exhibited further ligamentous injuries and/or atlas fractures. Their Mean Age-Adjusted Charlson Comorbidity Index (CCI) was 5.3 points (range 3-12), while mean American Society of Anesthesiologists (ASA) scores averaged 2.9 (range 2-4).
Results: The mean operating time was 55.8 minutes, there were no intraoperative complications, and there was minimal blood loss in all cases. The most common medical complications included; aspiration pneumonia (24.1%, n=7), altered mental status (17.2%, n=5), and cardiac decompensation (6.9%, n=2). One patient with delayed dysphagia and an infected implant resulting in loosening/dislocation, required implant removal, and long term antibiotic therapy. The 30-day mortality rate was 13.8% (4 patients), and the 1-year mortality rate was 27.6% (8 patients).
Conclusion: Anterior transarticular C1/2/odontoid fixation with reduced pharyngeal mobilization and shorter operative times, was associated with high morbidity/mortality rates. Dysphagia/ aspiration were the major postoperative complications leading to some deaths especially in patients with dementia/parkinsonism.
Introduction: In patients over 75 years of age, we applied a modified anterior transarticular C1/2 fixation with reduced pharyngeal mobilization vs. the standard anterior triple/quadruple osteosynthesis procedures.
Material/Methods: From 2010 - 2018, 29 patients underwent a modified anterior transarticular C1/2 fixation utilizing single odontoid screw fixation via a right-sided Smith-Robinson- (i.e. short and steep screw trajectory for the right and long trajectory for the left side) approach. All the patients were 75 years of age or older (mean age 82.6), and had sustained odontoid type II fractures. Additionally, asubset exhibited further ligamentous injuries and/or atlas fractures. Their Mean Age-Adjusted Charlson Comorbidity Index (CCI) was 5.3 points (range 3-12), while mean American Society of Anesthesiologists (ASA) scores averaged 2.9 (range 2-4).
Results: The mean operating time was 55.8 minutes, there were no intraoperative complications, and there was minimal blood loss in all cases. The most common medical complications included; aspiration pneumonia (24.1%, n=7), altered mental status (17.2%, n=5), and cardiac decompensation (6.9%, n=2). One patient with delayed dysphagia and an infected implant resulting in loosening/dislocation, required implant removal, and long term antibiotic therapy. The 30-day mortality rate was 13.8% (4 patients), and the 1-year mortality rate was 27.6% (8 patients).
Conclusion: Anterior transarticular C1/2/odontoid fixation with reduced pharyngeal mobilization and shorter operative times, was associated with high morbidity/mortality rates. Dysphagia/ aspiration were the major postoperative complications leading to some deaths especially in patients with dementia/parkinsonism.