Atlantoaxial Instability in Patients Older Than 70 Years: What Is the Outcome When Further Conservative Treatment Is Not an Option?

作者：Scholz Christoph^*; Klingler Jan Helge; Scheiwe Christian; Naseri Yashar; Masalha Waseem; Hubbe UIrich

来源：Journal of Neurological Surgery Part A-Central European Neurosurgery, 2018, 79(5): 372-379.

DOI：10.1055/s-0038-1646958

• cervical spine
• elderly
• geriatric
• spondylodesis
• atlantoaxial instability

Objective We report on our experiences of navigated posterior C1-C2 spondylodesis in the elderly ( 70 years of age).
Patients This retrospective cohort study evaluated all patients70 years of age treated with navigated posterior spondylodesis C1-C2 (at the most to C3) from 2008 to 2015 with a minimum follow-up of 1 year. Minor and major complications within 30 days after surgery, patient outcome, and the rate of solid fusion in computed tomography were recorded. The follow-up over 1year was conducted by outpatient examinations and via telephone interviews.
Results Twenty-two patients with a mean age of 79.9 years (range: 71-91 years) were treated. Minor complications were mild pneumonia (18.2%), postoperative confusion (9.1%), and urinary tract infection (4.5%). Major complications were severe pneumonia (4.5%) and clinically asymptomatic vertebral artery injury (4.5%). The mortality rate was 13.6% ( n =3) within the first 30 days after surgery and 22.7% ( n =5) within 1 year. All deceased patients were>85 years of age.
Conclusion In our patient population, posterior spondylodesis was shown to be beneficial for patients>70 years up to age approximate to 85 years. The mortality rate increased sharply in patients>85 years. In these patients the indication for surgery should be critically evaluated.

• 出版日期2018-9