Early mortality and morbidity following a type II odontoid fracture in the elderly

The Surgeon ◽  
2018 ◽  
Vol 16 (5) ◽  
pp. 297-301 ◽  
Author(s):  
Hassaan Q. Sheikh ◽  
Michael Athanassacopoulos ◽  
Arpan B. Doshi ◽  
Lee Breakwell ◽  
Ashley Cole ◽  
...  
Keyword(s):  
The Elderly ◽  
Early Mortality ◽  
Odontoid Fracture ◽  
Type Ii ◽  
Mortality And Morbidity

scholarly journals Treatment of type II odontoid fracture in the elderly

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Preci Hamilton ◽  
Peyton Lawrence ◽  
Christian Valentin Eisenring
Keyword(s):  
Screw Fixation ◽  
Holistic Approach ◽  
The Elderly ◽  
Spinal Fracture ◽  
Cannulated Screw ◽  
Odontoid Fracture ◽  
Zenker’S Diverticulum ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Zenker's Diverticulum

Abstract Odontoid fractures constitute the commonest cervical spinal fracture in the elderly. There are varied management approaches with paucity of robust evidence to guide decision-making. We review the case of a 92-years-old man with traumatic Grauer type II B odontoid fracture treated with anterior cannulated screw fixation. Postoperatively, he was noted to have dysphagia due to a zenker’s diverticulum. Further history revealed repair of a zenker’s diverticulum ~40 years prior. Cervical spine images and video fluoroscopy demonstrated a recurrent zenker’s diverticulum. After re-excision of the recurrent zenker’s diverticulum his dysphagia resolved. This unique case describes dysphagia due to recurrent zenker’s diverticulum presenting after anterior cannulated screw fixation for type II B odontoid fracture. The dysphagia was diagnosed and treated in close collaboration with speech and language therapists and otorhinolaryngologist. This underscores the importance of holistic approach to the elderly patient with odontoid fractures.

scholarly journals Incidence of dysphagia after odontoid screw fixation of type II odontoid fracture in the elderly

2018 ◽  
Vol 9 (1) ◽  
pp. 84 ◽  
Author(s):  
RudyD Marciano III ◽  
Brian Seaman ◽  
Saurabh Sharma ◽  
Teresa Wood ◽  
Chris Karas ◽  
...  
Keyword(s):  
Screw Fixation ◽  
The Elderly ◽  
Odontoid Fracture ◽  
Type Ii

Anterior Screw Fixation in Type II Odontoid Fractures: Is There a Difference in Outcome between Age Groups?

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1089-1094
Author(s):  
Wolfgang Börm ◽  
Erich Kast ◽  
Hans-Peter Richter ◽  
Klaus Mohr
Keyword(s):  
Conservative Management ◽  
Screw Fixation ◽  
The Elderly ◽  
Odontoid Fracture ◽  
High Rate ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Group 2 ◽  
Rate Of Failure ◽  
Group 1

Abstract OBJECTIVE Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly. METHODS We performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls. RESULTS There were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied. CONCLUSION Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.

Cervical 1-2 Posterior Instrumented Fusion Utilizing Computer-Assisted Navigation With Harvest of Rib Strut Autograft: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Timothy J Yee ◽  
Michael J Strong ◽  
Matthew S Willsey ◽  
Mark E Oppenlander
Keyword(s):  
Surface Area ◽  
Odontoid Process ◽  
Odontoid Fracture ◽  
Patient Specific ◽  
Computer Assisted ◽  
Type Ii ◽  
Instrumented Fusion ◽  
Assisted Navigation ◽  
Patient Consent ◽  
Posterior Instrumented Fusion

Abstract Nonunion of a type II odontoid fracture after the placement of an anterior odontoid screw can occur despite careful patient selection. Countervailing factors to successful fusion include the vascular watershed zone between the odontoid process and body of C2 as well as the relatively low surface area available for fusion. Patient-specific factors include osteoporosis, advanced age, and poor fracture fragment apposition. Cervical 1-2 posterior instrumented fusion is indicated for symptomatic nonunion. The technique leverages the larger posterolateral surface area for fusion and does not rely on bony growth in a watershed zone. Although loss of up to half of cervical rotation is expected after C1-2 arthrodesis, this may be better tolerated in the elderly, who may have lower physical demands than younger patients. In this video, we discuss the case of a 75-yr-old woman presenting with intractable mechanical cervicalgia 7 mo after sustaining a type II odontoid fracture and undergoing anterior odontoid screw placement at an outside institution. Cervical radiography and computed tomography exhibited haloing around the screw and nonunion across the fracture. We demonstrate C1-2 posterior instrumented fusion with Goel-Harms technique (C1 lateral mass and C2 pedicle screws), utilizing computer-assisted navigation, and modified Sonntag technique with rib strut autograft.  Posterior C1-2-instrumented fusion with rib strut autograft is an essential technique in the spine surgeon's armamentarium for the management of C1-2 instability, which can be a sequela of type II dens fracture. Detailed video demonstration has not been published to date.  Appropriate patient consent was obtained.

The Mental Efficiency of the Elderly Person with Type II Diabetes Mellitus

1990 ◽  
Vol 38 (5) ◽  
pp. 505-510 ◽  
Author(s):  
Richard C. U'Ren ◽  
Matthew C. Riddle ◽  
Muriel D. Lezak ◽  
Margaret Bennington-Davis
Keyword(s):  
Diabetes Mellitus ◽  
Type Ii Diabetes ◽  
Elderly Person ◽  
The Elderly ◽  
Type Ii Diabetes Mellitus ◽  
Type Ii ◽  
Mental Efficiency

scholarly journals Effects of Vitamin A Supplementation on Immune Responses and Correlation with Clinical Outcomes

2005 ◽  
Vol 18 (3) ◽  
pp. 446-464 ◽  
Author(s):  
Eduardo Villamor ◽  
Wafaie W. Fawzi
Keyword(s):  
Vitamin A ◽  
Clinical Outcomes ◽  
Age Groups ◽  
Lymphocyte Activation ◽  
The Elderly ◽  
Conclusive Evidence ◽  
Vitamin A Supplementation ◽  
Mortality And Morbidity ◽  
Severe Diarrhea ◽  
Positive Effects

SUMMARY Vitamin A supplementation to preschool children is known to decrease the risks of mortality and morbidity from some forms of diarrhea, measles, human immunodeficiency virus (HIV) infection, and malaria. These effects are likely to be the result of the actions of vitamin A on immunity. Some of the immunomodulatory mechanisms of vitamin A have been described in clinical trials and can be correlated with clinical outcomes of supplementation. The effects on morbidity from measles are related to enhanced antibody production and lymphocyte proliferation. Benefits for severe diarrhea could be attributable to the functions of vitamin A in sustaining the integrity of mucosal epithelia in the gut, whereas positive effects among HIV-infected children could also be related to increased T-cell lymphopoiesis. There is no conclusive evidence for a direct effect of vitamin A supplementation on cytokine production or lymphocyte activation. Under certain circumstances, vitamin A supplementation to infants has the potential to improve the antibody response to some vaccines, including tetanus and diphtheria toxoids and measles. There is limited research on the effects of vitamin A supplementation to adults and the elderly on their immune function; currently available data provide no consistent evidence for beneficial effects. Additional studies with these age groups are needed.

Operative Versus Nonoperative Management of Odontoid Fracture in the Elderly: Stochastic Simulation of Morbidity and Mortality

2011 ◽  
Vol 11 (10) ◽  
pp. S107
Author(s):  
Suneel Bhat ◽  
Christopher Kepler ◽  
Kris Radcliff ◽  
Jeffrey Rihn ◽  
Todd Albert ◽  
...  
Keyword(s):  
Stochastic Simulation ◽  
Nonoperative Management ◽  
The Elderly ◽  
Odontoid Fracture ◽  
Morbidity And Mortality

Comparing polymer-filled versus self-expanding endografts in Chinese patients

2018 ◽  
Vol 26 (9) ◽  
pp. 667-676
Author(s):  
Yuk Law ◽  
Yiu Che Chan ◽  
Stephen Wing-Keung Cheng
Keyword(s):  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
The Self ◽  
Chinese Patients ◽  
Type Ii ◽  
Mortality And Morbidity ◽  
Type Ia ◽  
One Year ◽  
Aneurysm Repair

Introduction We performed a single-center nonrandomized study on patients who underwent endovascular aneurysm repair using polymer-filled or other self-expanding endografts. Methods Consecutive patients with asymptomatic infrarenal abdominal aortic aneurysms who underwent endovascular repair were retrospectively reviewed. They were divided into a polymer-filled ( n = 20) or self-expanding group ( n = 42). Baseline characteristics, operative mortality and morbidity, and follow-up data were compared. Results Aneurysm diameter, neck and iliac morphologies did not differ between the two groups. Technical success was 100%. The 30-day mortality was 0% and 2.4% in the polymer-filled and self-expanding group, respectively. At a mean follow-up of 17 months, the changes in sac size were −2.1 mm and −5.1 mm ( p = 0.144) at one year, and −3.5 mm and −7.7 mm ( p = 0.287) at 2 years in the polymer-filled and self-expanding group, respectively. The polymer-filled group had 7 (35%) type II endoleaks, and the self-expanding group had 1 (2.4%) type Ia and 13 (31%) type II endoleaks. Neck diameter remained stable in the polymer-filled stent-grafts whereas there was progressive neck degeneration in the self-expanding group. The rates of reintervention and overall survival were similar in both groups. The presence of an endoleak was the only predictor of non-regression of the aneurysm (odds ratio = 17.00, 95% confidence interval: 4.46–64.88, p < 0.001). Conclusion Polymer-filled endografts had similar safety, effectiveness, and durability to other self-expanding endografts. The major advantage is the small iliofemoral access. They also have the potential long-term benefit of a more stable neck.

scholarly journals Cardiac surgery in the elderly: What goals of care?

2017 ◽  
Vol 87 (2) ◽  
Author(s):  
Alessandra Pratesi ◽  
Francesco Orso ◽  
Camilla Ghiara ◽  
Aldo Lo Forte ◽  
Anna Chiara Baroncini ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
The Elderly ◽  
Risk Scores ◽  
Frailty Phenotype ◽  
Mortality And Morbidity ◽  
Geriatric Cardiology ◽  
Patient Reported ◽  
Short Term Mortality ◽  
Surgery In The Elderly

<p>At present, the majority of cardiac surgery interventions have been performed in the elderly with successful short-term mortality and morbidity, however significant difficulties must to be underlined about our capacity to predict long-term outcomes such as disability, worsening quality of life and loss of functional capacity.<br />The reason probably resides on inability to capture preoperative frailty phenotype with current cardiac surgery risk scores and consequently we are unable to outline the postoperative trajectory of an important patients’ centered outcome such as disability free survival. In this perspective, more than one geriatric statements have stressed the systematic underuse of patient reported outcomes in cardiovascular trials even after taking account of their relevance to older feel and wishes. Thus, in the next future is mandatory for geriatric cardiology community closes this gap of evidences through planning of trials in which patients’ centered outcomes are considered as primary goals of therapies as well as cardiovascular ones.</p>

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