title: Age increases the risk of immediate postoperative dysphagia and pneumonia after odontoid screw fixation.
abstract: BACKGROUND
  Type II odontoid fractures are the most common spinal fracture in the elderly population and may be managed with halo immobilization, posterior fusion, and anterior odontoid screw fixation. Anterior odontoid screw fixation has several advantages over posterior fusion, including: reduced surgical time, decreased post-operative pain, preserved range of motion, earlier mobilization, and decreased postoperative narcotic requirement. We review our experience using anterior odontoid screw fixation in type II odontoid fractures in the elderly and non-elderly populations.
  
  
  METHODS
  Demographic and outcome data were retrospectively collected in 30 consecutive patients with type II odontoid fractures treated with anterior odontoid screw fixation.
  
  
  RESULTS
  Mean patient age was 70.7 (range 20-92); 18 of the patients were male and 12 were female. All patients had successful placement of a single anterior odontoid screw without intra-operative complication. Complications included pneumonia in nine patients (30%), gastrostomy tube placement due to patient failing swallow evaluation in 13 patients (43%), and vocal cord paralysis in one patient (3.3%). Patients over the age of 75 accounted for 12 of the 13 (92%) gastrostomy tube placements and eight of the nine (88.9%) pneumonias, respectively. The difference in rates of gastrostomy tube placement and pneumonia for the older patients were both found to be statistically significant with P<.0001 for gastrostomy tubes and P<.02 for pneumonias.
  
  
  CONCLUSIONS
  Anterior odontoid screw fixation is an effective treatment option for patients with Type II odontoid fractures. In the elderly population, however, the benefits of the procedure must be weighed against the risks of postoperative dysphagia requiring gastrostomy and pneumonia.
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, United States.
authors.forename: K
authors.initials: K
authors.lastname: Vasudevan
authors.affiliation: Department of Neurosurgery, Emory University School of Medicine, United States. Electronic address: JonathanGrossberg@gmail.com.
authors.forename: J A
authors.initials: JA
authors.lastname: Grossberg
authors.affiliation: Department of Neurosurgery, University of Utah School of Medicine, United States.
authors.forename: H S
authors.initials: HS
authors.lastname: Spader
authors.affiliation: Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, United States.
authors.forename: R
authors.initials: R
authors.lastname: Torabi
authors.affiliation: Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, United States.
authors.forename: A A
authors.initials: AA
authors.lastname: Oyelese
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries / Q000601:surgery*; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D016103:Spinal Fractures / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Odontoid fracture; Postoperative dysphagia