頚椎歯突起骨折の治療成績

―年齢, 背景因子, 画像評価に基づいた検討―

抄録

  Objective : Odontoid fractures are the most common cervical injuries among the elderly population. We evaluated treatment outcome in 14 patients with odontoid fractures who were treated at our institute between 2003 and 2016. Additionally, in this report, we discuss the optimal treatment option for odontoid fractures in the elderly population and provide a literature review.

  Results : Patient age ranged 19-90 (average, 60.6) years, and the patients included five (36%) octogenarians. According to Anderson’s classification, four cases (29%) were type II and 10 cases (71%) were type III odontoid fractures. Surgical intervention was performed in 12 cases, including anterior odontoid screw fixation in nine, posterior cervical instrumented fusion in four (including reoperation after anterior screw fixation in one), and conservative treatment with halo vest fixation in two. Moreover, 13 patients received radiographic follow-up, and 11 (85%) attained bone fusion. In octogenarians, three (60%) of five cases attained bone fusion through anterior screw fixation.

  Conclusion : In the elderly population, tailor-made treatment is necessary according to systemic diseases, activities of daily living, and radiographic assessment of odontoid fractures in addition to Anderson’s classification.