Surgical and nonsurgical treatment of closed C2 fractures yield similar 30-day mortality and complication rates in elderly patients, according to researchers at the Stanford University School of Medicine.
"Surgery should not be excluded as an intervention if the physician believes it to be the better treatment option,” the authors wrote in their study.
The researchers conducted a retrospective review of elderly patients undergoing either surgical treatment or nonsurgical immobilization of closed C2 fractures. They treated 28 patients surgically and 28 nonsurgically. They included patients without spinal cord injuries at least 65 years or older between 2000 and 2010. Surgical patients underwent surgery to fuse one or more vertebra. The immobilized patients wore a cervical collar for several weeks. Patients undergoing surgery had more displaced fractures at 4 mm vs. 1 mm for the nonsurgical group. Outcome measures included 30-day mortality and complication rates, length of hospital stay and long-term survival.
The 30-day mortality was 3.6% in the surgical group vs. 7.1% in the nonsurgical group. The complication rates were 17.9% in the surgical group and 25% in the nonsurgical group, which was not statistically significant. The surgical patients had longer hospital stays at 11.8 days vs. 4.4 days in the nonsurgical group. Long-term survival was not statistically significant.
"The data… demonstrate equivalent complications and mortality, where both groups were of similar age and overall health,” the authors wrote.
Chen YR, Boakye M, Arrigo RT, et al. Morbidity and mortality of C2 fractures in the elderly: surgery and conservative treatment. Neurosurgery. 2012; 70(5):1055-1059.