C Y Barrey1,2, A di Bartolomeo3, L Barresi4, N Bronsard4, J Allia4, B Blondel5, S Fuentes5, B Nicot6, V Challier7, J Godard8, P Marinho9, P Kouyoumdjian10, M Lleu11, N Lonjon12, E Freitas13, J Berthiller14, Y P Charles15. 1. Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France. c.barrey@wanadoo.fr. 2. Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France. c.barrey@wanadoo.fr. 3. Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University, Roma, Italy. 4. Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France. 5. Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France. 6. Department of Neurosurgery, CHU de Grenoble, Avenue Maquis-du-Grésivaudan, 38700, Grenoble-La Tronche, France. 7. Department of Orthopaedic Surgery, Hôpital Tripode, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076, Bordeaux cedex, France. 8. Department of Spine Surgery, Hôpital Jean-Minjoz, 3 boulevard A Fleming, 25030, Besançon, France. 9. Department of Neurosurgery, Hôpital Roger-Salengro, CHRU de Lille, Rue Emile-Laine, 59037, Lille, France. 10. Department of Orthopaedic Surgery, CHU de Nîmes, Avenue du Pr Debré, 30000, Nîmes, France. 11. Department of Neurosurgery, CHU de Dijon, 14 rue Paul Gaffarel, 21000, Dijon, France. 12. Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France. 13. Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France. 14. Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 Avenue Lacassagne, 69424, Lyon, France. 15. Department of Spine Surgery, Hopitaux Universitaires de Strasbourg, 1 place de l'Hopital, BP 426, 67091, Strasbourg, France.
Abstract
BACKGROUND: C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS: A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS: A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS: C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.
BACKGROUND: C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS: A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS: A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS: C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.
Authors: Mitchel B Harris; William M Reichmann; Christopher M Bono; Kim Bouchard; Kelly L Corbett; Natalie Warholic; Josef B Simon; Andrew J Schoenfeld; Lawrence Maciolek; Paul Corsello; Elena Losina; Jeffrey N Katz Journal: J Bone Joint Surg Am Date: 2010-03 Impact factor: 5.284
Authors: Sanjay S Dhall; John K Yue; Ethan A Winkler; Praveen V Mummaneni; Geoffrey T Manley; Phiroz E Tarapore Journal: Neurosurgery Date: 2017-06-01 Impact factor: 4.654