The surgical treatment of upper cervical spine trauma in octogenerians.

Introduction: Surgical treatment of upper cervical spine injuries in older patients is increasing in high-income countries and carries risks due to comorbidities, impaired general health, and osteoporosis. Research question: The aim of this study was to compare the surgical outcomes in patients aged 80-90 years who underwent surgical treatment for upper cervical spine fractures with those in a younger population. Materials and methods: All patients who underwent navigated dorsal stabilization of upper cervical spine trauma with automated intraoperative CT (iCT)-based registration at a single institution were retrospectively analyzed. Clinical and radiological outcomes were compared between patients over and under 80 years of age. Results: A total of 61 patients underwent dorsal stabilization after a C1/2 fracture. The mean age was 72.3 ± 16.4 years; 31 patients (50.8 %) were 80 years or older. Forty patients had an isolated C2 fracture, 18 patients had combined C1 and C2 fractures, and three patients had a simultaneous C2 and C3 fracture. All patients were registered intraoperatively and scanned intraoperatively to check the screw position. No screw misplacements occurred. The clinical and radiological results did not differ between the group of patients over 80 years of age and the group of patients under 80 years of age (p > 0.05). Discussion and conclusion: Surgical treatment of upper cervical spine injuries in elderly patients is as safe and effective as in younger patients. Despite higher mortality and longer hospital stays, surgical outcomes were comparable in terms of complications and fusion rates.