Morbidity and Mortality of C2 Fractures in the Elderly Surgery and Conservative Treatment


Authors: Chen YR, Boakye M, Arrigo RT, Kalanithi PS, Cheng I, Alamin T, Carragee EJ, Mindea SA, Park J.

Source: Neurosurgery. 2011 Dec 6.


Chen et al. found that 30-day mortality and complication rates between surgically and non-surgically treated patients with C2 fractures were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone was not found to be a contraindication for surgical fixation of C2 fractures.

The authors state that: "Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients".

The authors retrospectively reviewed 28 surgically and 28 non-surgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates, secondary outcomes were length of stay and long-term survival.

The authors found that: "Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group and 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of stay than non-surgical patients (11.8 v. 4.4 days). Long-term median survival was not significantly different between groups".

Conclusion of the authors: "30-day mortality and complication rates between surgically and non-surgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication for surgical fixation of C2 fractures".


Link for the abstract: http://www.ncbi.nlm.nih.gov/pubmed/22157549


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