scholarly journals Treatment of type II odontoid fracture in the elderly

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Screw Fixation ◽  
Holistic Approach ◽  
The Elderly ◽  
Spinal Fracture ◽  
Cannulated Screw ◽  
Odontoid Fracture ◽  
Zenker’S Diverticulum ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

Anterior Screw Fixation in Type II Odontoid Fractures: Is There a Difference in Outcome between Age Groups?

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1089-1094
Author(s):  
Wolfgang Börm ◽  
Erich Kast ◽  
Hans-Peter Richter ◽  
Klaus Mohr
Keyword(s):  
Conservative Management ◽  
Screw Fixation ◽  
The Elderly ◽  
Odontoid Fracture ◽  
High Rate ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Group 2 ◽  
Rate Of Failure ◽  
Group 1

Abstract OBJECTIVE Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly. METHODS We performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls. RESULTS There were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied. CONCLUSION Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.

P22. Anterior Screw Fixation in Type II Odontoid Fractures: Is it a Reliable Method in the Elderly?

2006 ◽  
Vol 6 (5) ◽  
pp. 94S
Author(s):  
Woo-Kie Min ◽  
Joo-Kyung Sung ◽  
In-Ho Jeon ◽  
Chang-Wug Oh ◽  
Shin-Yoon Kim ◽  
...  
Keyword(s):  
Reliable Method ◽  
Screw Fixation ◽  
The Elderly ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation

scholarly journals Incidence of dysphagia after odontoid screw fixation of type II odontoid fracture in the elderly

2018 ◽  
Vol 9 (1) ◽  
pp. 84 ◽  
Author(s):  
RudyD Marciano III ◽  
Brian Seaman ◽  
Saurabh Sharma ◽  
Teresa Wood ◽  
Chris Karas ◽  
...  
Keyword(s):  
Screw Fixation ◽  
The Elderly ◽  
Odontoid Fracture ◽  
Type Ii

scholarly journals Type II odontoid fractures in the elderly: early failure of nonsurgical treatment

2000 ◽  
Vol 8 (6) ◽  
pp. 1-6 ◽  
Author(s):  
Charles Kuntz ◽  
Sohail K. Mirza ◽  
Abel D. Jarell ◽  
Jens R. Chapman ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Screw Fixation ◽  
The Elderly ◽  
Mortality Rates ◽  
Nonsurgical Treatment ◽  
Morbidity And Mortality ◽  
Type Ii ◽  
Geriatric Population ◽  
Odontoid Fractures ◽  
Nonsurgical Management ◽  
Cervical Orthosis

The optimum treatment of Type II odontoid fractures in the geriatric population remains controversial. Coexisting medical conditions encountered in the elderly patient often increase operative risk and make cervical immobilization difficult to tolerate. Previous studies have shown increased morbidity and mortality and decreased fusion rates for Type II odontoid fractures treated with cervical orthoses in the geriatric population, whereas low morbidity and mortality rates with operative management have recently been documented. To investigate the role of surgical and nonsurgical treatment, a retrospective analysis was performed of patients with Type II odontoid fractures who were at least 65 years old and were consecutively admitted to a single medical center from 1994 to 1998. Twenty patients met inclusion criteria. In 12 patients nonsurgical management with a cervical orthosis was attempted. The nonsurgical management failed early in six patients, with one associated death. Eleven patients were treated surgically with either anterior odontoid screw fixation or posterior C1–2 transarticular screw fixation and modified Gallie fusion. Postoperatively one patient required revision of the C1–2 transarticular screws, and there was one death. In conclusion Type II odontoid fractures in this elderly population were associated with early 10% morbidity and 20% mortality rates. Nonsurgical management of Type II odontoid fractures failed early in six (50%) of 12 patients, whereas surgical treatment failed early in one of 11 (9%) patients. Both the nonsurgical and surgical treatments resulted in approximately 10% morbidity and 10% mortality rates.

Biomechanical comparison of cemented versus non-cemented anterior screw fixation in type II odontoid fractures in the elderly: a cadaveric study

2018 ◽  
Vol 18 (10) ◽  
pp. 1888-1895 ◽  
Author(s):  
Petr Rehousek ◽  
Edward Jenner ◽  
James Holton ◽  
Marcin Czyz ◽  
Lukas Capek ◽  
...  
Keyword(s):  
Screw Fixation ◽  
The Elderly ◽  
Cadaveric Study ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Anterior Screw Fixation ◽  
Biomechanical Comparison

scholarly journals Endoscopic treatment of Zenker’s diverticulum with Ligasure: simple, safe and effective

2019 ◽  
Vol 07 (02) ◽  
pp. E203-E208 ◽  
Author(s):  
Pilar Diez Redondo ◽  
Henar Núñez Rodríguez ◽  
Marina de Benito Sanz ◽  
Raúl Torres Yuste ◽  
Manuel Pérez-Miranda
Keyword(s):  
Clinical Success ◽  
The Elderly ◽  
Flexible Endoscopy ◽  
Zenker’S Diverticulum ◽  
Delayed Bleeding ◽  
Zenker's Diverticulum ◽  
Second Procedure ◽  
Tissue Sealing

Abstract Background and study aims Zenker's diverticulum may cause disabling symptoms, especially in the elderly. Treatment has changed in recent decades from open surgery to management with flexible endoscopy, resulting in lower morbidity and mortality. The goal of this study was to present the largest series, with the longest follow-up, of patients with Zenker's diverticulum receiving outpatient treatment with flexible endoscopy using a diverticuloscope and Ligasure (Covidien, Minneapolis, Minnesota, United States), a device that allows tissue sealing and coagulation of vessels before cutting the septum between the diverticulum and esophagus. Patients and methods We performed 79 diverticulotomies in 69 patients (65.2 % male, mean age 73.4 years). The mean diverticulum size was 2.8 cm. In three cases with a diverticulum ≤ 1.5 cm, the diverticuloscope could not be placed. Results The technical success was 95.83 % and the clinical success 96.7 %: 84 % of the 56 patients followed for a mean of 34.6 months (24 – 64 months) had no dysphagia. The recurrence rate was 10.4 %, with a good response to a second diverticulotomy at 12 months (IQR: 11.5 – 17) in most cases. The most severe complications were two microperforations, resolved with conservative treatment, and one case of delayed bleeding endoscopically-controlled with a clip. Conclusions Diverticulotomy of the esophageal-diverticular septum with Ligasure is an outpatient endoscopic technique that is simple, effective in the long term and very safe for the treatment of patients with Zenker's diverticulum. In symptomatic recurrences, a second procedure was equally safe and effective in most patients.

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