THE EFFICACY AND SAFETY OF CERVICAL SPINE IMMOBILIZATION IN ELDERLY PATIENTS WITH CERVICAL SPINE FRACTURES: A SYSTEMATIC REVIEW
| Autor: | S. Epton, R. Preece, D. Hay, M. kaminaris, D. Lui |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | Basrah Journal of Surgery, Vol 26, Iss 1, Pp 38-45 (2020) |
| Druh dokumentu: | article |
| ISSN: | 1683-3589 2409-501X |
| DOI: | 10.33762/bsurg.2020.165466 |
| Popis: | As both life expectancy and average population age continue to rise, so too does the incidence of cervical spine (c-spine) injuries. C-spine fractures are associated with high morbidity and mortality, but the question is how best to treat them? This review is to compare the safety and efficacy of c-spine immobilisation in a rigid collar with other treatment modalities in elderly population. Available literature was reviewed to determine how treatment efficacy is assessed, with particular focus on whether osseous union or fibrous non-bony union should be considered as a successful outcome. This study was designed in accordance with PRISMA guidelines. Pubmed/Medline databases were selected for analysis. When considering patients over the age of 65, it is unclear whether management with a collar is safer than operative management or immobilisation with HALO vest. However, amongst studies that further subdivide elderly patients according to age there is more of a consensus; it appears that in those under the age of 75, operative management is safer, whereas in those over the age of 85, immobilisation in a collar is associated with lower mortality rates. Between the ages of 75-85 there is less clarity. Osseous union occurs more commonly in patients managed operatively, but fibrous non-bony union was not associated with any adverse outcomes in these studies. Conclusion: At present, there are no randomised controlled trials that have tried to delineate whether management in a collar is safer or more effective than other treatments such as HALO vest or operative fixation. However, evidence from various cohort studies does suggest that “elderly” patients with c-spine fractures should not be considered as one homogenous cohort, but should instead be subdivided according to age. Interestingly, these studies suggest that fibrous non-bony union may be an adequate treatment outcome in older. Further research into this complex field is required. Keywords: Trauma, elderly care, spinal fractures, treatment outcome, survival rate |
| Databáze: | Directory of Open Access Journals |
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