2018 AANS Annual Scientific Meeting-C1-2 Fractures in the Elderly

Video Transcription

Video Summary

In this video, Dr. Srini Prasad, a neurosurgeon at Jefferson, discusses the management of type 2 odontoid fractures in elderly patients. He begins by acknowledging the biases of his institution towards surgery for these fractures. He emphasizes that type 2 odontoid fractures in elderly patients have different characteristics compared to younger individuals, including lower energy mechanisms and a lack of associated injuries. The increasing incidence of these fractures in an aging population is highlighted, necessitating a need for effective treatment options. Dr. Prasad acknowledges the lack of high-quality data and skepticism towards existing evidence. He presents various options for managing type 2 odontoid fractures, including non-surgical approaches (benign neglect, collars, or halos) and surgical approaches (anterior or posterior fixation). The benefits and drawbacks of each method are discussed, with a focus on fusion rates, complications, and mortality. Dr. Prasad presents a meta-analysis that supports a survival advantage and equivalent morbidity between surgical and non-surgical management. He concludes that non-operative management carries a higher risk of poor outcomes and that posterior fixation is a reasonable surgical option. A case study is presented to illustrate the complexity and potential complications associated with type 2 odontoid fractures. The role of osteoporosis management and considerations for elderly patients are briefly mentioned. Overall, the video provides an overview of the current understanding and challenges in managing type 2 odontoid fractures in elderly patients.

Asset Caption

Srinivas K. Prasad, MD, FAANS

Keywords

type 2 odontoid fractures

elderly patients

management

surgical approaches

non-surgical approaches