Vertebral fracture and treatment in elderly

Spinal injuries referring to banal falls are common injuries in elderly per sons. Up to 55 years of age spinal fractures are more frequent in men while its opposite in older persons. There are two typical lesions: odontoid fra cture in the upper cervical spine and compression fracture in thoracolumbar spine. Odontoid fracture is the most frequent lesion in cervical spine in the elderly. This is caused by trabecular structure of dens axis and spine' s stiffness in old age. Instable fractures in extension type II are most co mmon. In many cases the instability of the lesion is hidden and can be firs t seen in functional examination controlled by x-ray. Conservative treatmen t is efficient in stable lesions type III while there is a high risk for ps eudarthrosis in treatment of instable lesions in elderly with Halo Fixateur e.g. We think that the best operation for these fractures is the anterior screw fixation. If this is not sufficient because of low bone mass or early dislocation of the screws a dorsal fusion C1/C2 with transarticular screwi ng e.g. should be done. Because of rare symptoms thoracolumbar fractures in osteoporosis are hidden frequently. In many cases it's not easy to disting uish acute lesions from healed fractures or tumor lesions. Neurological def icit is rare. Therefore there are just few compression fractures (A type) t hat have to be treated operatively. Instable lesions type B and C must be o perated as well in the elderly as in the young. Because of low bone mass in elderly the dorsal instrumentation should include more than just the two i njured segments. An even more adequate stabilisation is done with an additi onal vertebral replacement.