Association between Cervical Spine Degeneration and the Presence of Dens Fractures

Marcel Betsch; Sabina Blizzard; Bala Krishnamoorthy; Jung Yoo

doi:10.1055/a-0853-8046

Zeitschrift für Orthopädie und Unfallchirurgie, Table of Contents

Z Orthop Unfall 2020; 158(01): 46-50
DOI: 10.1055/a-0853-8046

Originalarbeit

Georg Thieme Verlag KG Stuttgart · New York

Association between Cervical Spine Degeneration and the Presence of Dens Fractures

Zusammenhang zwischen der Degeneration der Halswirbelsäule und dem Vorhandensein von Dens-Frakturen

Authors

Marcel Betsch

¹Department of Orthopaedics, Universitätsklinikum Aachen
Sabina Blizzard

²Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, United States
Bala Krishnamoorthy

³Department of Mathematics, Washington State University – Vancouver, Washington, United States
Jung Yoo

²Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon, United States

Abstract

Purpose Results of a small case series indicate an increased risk of dens fractures in patients with osteoarthritis. The purpose of this retrospective cohort study was to analyze the relative risks associated with degeneration of the cervical spine in the occurrence of dens fractures in older patients.

Methods We performed a retrospective CT study of 1,794 patients > 55 years of age with and without dens fractures for signs of osteoarthritis (OA).

Results OA of the atlanto-dens interval (AdI) was present in 75.9% of fracture patients, whereas 63.5% of non-fracture patients had OA of the AdI (p = 0.04). In cases of osteoarthritis of the facet joints, we did find a significant increase (p < 0.05) in the dens fracture risk in patients with OA.

Conclusions This study indicates an association between OA of the cervical spine and the risk of sustaining a dens fracture. OA can lead to a reduction in the range of motion of the cervical spine. As a consequence, a relatively low-energy trauma can induce a forced sagittal motion, which will produce a torque at the base of the odontoid process resulting in a fracture.

Zusammenfassung

Einleitung Die Ergebnisse bisher veröffentlichter kleiner Fallserien zeigen ein erhöhtes Risiko für Densfrakturen bei Patienten mit Arthrose der HWS. Ziel dieser retrospektiven Kohortenstudie war die Untersuchung des relativen Risikos, das mit der Degeneration der Halswirbelsäule beim Auftreten von Densitätsfrakturen bei älteren Patienten verbunden ist.

Methoden Wir untersuchten im Rahmen einer retrospektiven CT-Studie 1.794 Patienten auf Arthrosezeichen (OA) der HWS im Alter von über 55 Jahren mit und ohne Densfrakturen.

Ergebnisse Bei 75,9% der Frakturpatienten lag eine OA des Atlanto-Dentalen-Intervalls (AdI) vor, während 63,5% der Patienten ohne Fraktur eine OA der AdI aufwiesen (p = 0,04). Bei Arthrose der Facettengelenke wurde ein signifikanter Anstieg (p < 0,05) des Densefrakturrisikos bei OA-Patienten festgestellt.

Diskussion Diese Studie weist auf einen Zusammenhang zwischen OA der Halswirbelsäule und dem Risiko einer Densfraktur hin. OA kann zu einer Verringerung der Beweglichkeit der Halswirbelsäule führen. Infolgedessen kann ein bereits relativ energiearmes Trauma an der Basis des Dens zu einem Drehmoment führen, das zu einem Bruch führen kann.

Key words

osteoarthritis - cervical spine degeneration - dens fractures - odontoid process

Schlüsselwörter

Arthrose - Verschleiß - Halswirbelsäule - Densfrakturen - Densfortsatz

Full Text

References

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