Treatment of remote type ii axis fractures in the elderly: feasibility of anterior odontoid screw fixation.
This preliminary study considers the feasibility and the results of anterior screw fixation in elderly patients with remote Type II axis fractures. Odontoid fractures are the most common fractures of the cervical spine in people 70 years of age or older. In developing countries, direct anterior fracture fixation is replacing posterior fusion in many cases. Recently, it has been demonstrated that patient age does not influence the outcome in terms of fusion after odontoid screw fixation. There is considerable disagreement about correct treatment in the case of remote fractures. In the literature, there have been no studies considering the feasibility and results of anterior screw fixation in elderly patients with remote Type II axis fractures. From 1989 to 2005, we observed 9 patients over the age of 65 years with isolated Type II remote fractures of the dens. All fractures were considered to be inveterate, as the traumatic events had occurred 6 to 12 months earlier. All fractures were treated with anterior infibulation of the dens with single 3.5-mm cannulated screws. A bony fusion was radiologically documented in 7 patients (77%) 4 to 16 months after the intervention. In 1 patient, a fibrous union was observed. The neurological status remained unchanged in all patients, and no patients showed any neurological impairment at the time of follow-up. According to our preliminary study, the technique appears to be feasible for remote axis fractures within 12 months of trauma, and it seems to be safe for elderly patients. Further data from additional studies are needed.