Abstract
Introduction: The management of cervical spine fracture, subluxation or dislocation in the elderly may present difficulties in decision-making. Frequently, the elderly suffer from medical comorbidity and a limited physiological reserve, which need to be considered in deciding on surgical versus conservative management of fractures and dislocations. Debate exists regarding the merits of surgical versus nonsurgical management of these injuries.1,2,4
Methods: Retrospective analysis of 16 patients with traumatic cervical spine fractures with or without dislocation or subluxation in patients greater than 65 years of age, spanning 1994 to the present were carried out. Success of spine stabilisation, time in hospital, ability to return to pre-injury function and medical or surgical complications were measured.
Results: The average age of the patients was 76 years with a range of 67–86 years of age. A variety of cervical injuries and fixation methods were identified, the most common injury being odontoid fracture requiring transarticular screw fixation. One patient died eight days post-operatively of cardiac arrest and a second patient died of pneumonia. One other complication of wound hematoma while the patient was taking anticoagulation therapy occurred. All other patients were discharged independent in activities of daily living. There were no cases of failure of surgery to restore stability. No post-operative neurological deterioration in any of the patients occurred.
Discussion: This study shows that surgical fixation of cervical fractures in the elderly can be performed as a safe and efficient form of management. Surgery decreases the period of both immobility and hospitalisation with subsequent decrease in the risk of complications such as deep vein thrombosis, pulmonary embolism and pneumonia3.Complications from immobilisation devices such as the halo-thoracic brace may also be avoided.
The abstracts were prepared by Dr Robert J. Moore. Correspondence should be addressed to him at The Spine Society of Australia, Institute of Medical and Veterinary Science, The Adelaide Centre for Spinal Research, Frome Road, Adelaide, South Australia 5000
References
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