CERVICAL-SPINE FRACTURES IN THE ELDERLY

BACKGROUND Cervical spine fractures in the elderly are relatively comm on. The management of such injuries may be complicated by underlying m edical debility and osteopenia as well as reduced tolerance to halo im mobilization. METHODS Over a 1-year period, 43 cervical spine fracture s were treated at our institution, Ten (23%) were in persons 70 years of age or older, This retrospective analysis describes the clinical fe atures, treatment, and outcome of these 10 elderly patients. All fract ures in this patient population involved the atlantoaxial complex, inc luding five combination C1-C2 fractures. Six patients were treated wit h early halo immobilization and three were initially managed with a ri gid cervical collar. Three patients required posterior cervical fusion . RESULTS Of the six patients undergoing halo immobilization, five pro gressed to osseous union. Three patients were immobilized in a Philade lphia collar resulting in one osseous union, one nonunion, and one dea th. Three patients underwent posterior cervical fusion with subsequent osseous union in all three. CONCLUSIONS Although external immobilizat ion with a halo device is our treatment of choice for most C1 and C2 f ractures in elderly patients, a Philadelphia collar is useful in selec t cases when halo immobilization or early surgical fusion is contraind icated, Posterior cervical fusion can be safely and effectively perfor med in elderly patients and should be strongly considered for initial therapy in the elderly with fracture types unlikely to progress to oss eous union with external immobilization alone. (C) 1997 by Elsevier Sc ience Inc.