Conservative Management of Type II Odontoid Fractures in Older People: A Retrospective Observational Comparison of Osseous Union Versus Nonunion

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S49-S49
Author(s):  
Suzanne McIlroy ◽  
Jordan Lam ◽  
Muhammad Faheem Khan ◽  
Asfand Baig Mirza ◽  
Jerry Ajayi Philip ◽  
...  
Keyword(s):  
Older People ◽  
Conservative Management ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Osseous Union

Conservative Management of Type II Odontoid Fractures in Older People: A Retrospective Observational Comparison of Osseous Union Versus Nonunion

Neurosurgery ◽  
2020 ◽  
Author(s):  
Suzanne McIlroy ◽  
Jordan Lam ◽  
Muhammad Faheem Khan ◽  
Asfand Baig Mirza ◽  
Jerry Ajayi Philip ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older People ◽  
Conservative Management ◽  
Demographic Data ◽  
Odontoid Fracture ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Pain Disability ◽  
Osseous Union

Abstract BACKGROUND Type II odontoid fractures are a common cervical fracture in older people. Lower osseous-union rates are reported in those treated conservatively compared to surgically; however, the clinical relevance of a nonunion is unknown. OBJECTIVE To compare pain, disability, and quality of life in older people following conservative management of type II odontoid fractures demonstrating osseous-union and nonunion. METHODS Electronic records were searched from 2008 to 2018 for adults ≥65 yr with type II odontoid fracture, managed in a semi-rigid collar. Clinical and demographic data were retrieved from electronic patient notes. Surviving patients were invited to complete questionnaires to assess pain, disability, and quality of life. Ethical approval was granted. RESULTS A total of 125 patients were identified: 36 (29%) demonstrated osseous-union, 89 (71%) had nonunion, of which 33 (40%) had radiological instability. Mean age at fracture was 84 yr (osseous-union 83 yr; nonunion 84 yr). A total of 53 had deceased (41 nonunion). Median length of survival was 77 mo for osseous-union vs 50 mo for nonunion; P = .02. No patient developed myelopathy during the follow-up period. Questionnaire response rate was 39 (58%). There were no statistically significant differences between the groups in terms of pain, disability, or quality of life (P > .05). Both groups reported mild disability and pain but low quality of life. CONCLUSION Management with a semi-rigid collar in older people with type II odontoid fracture is associated with low levels of pain and disability without statistically significant differences between those demonstrating osseous-union or stable or unstable nonunions. Conservative management appears to be a safe treatment for older people with type II fractures.

Anterior Screw Fixation in Type II Odontoid Fractures: Is There a Difference in Outcome between Age Groups?

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1089-1094
Author(s):  
Wolfgang Börm ◽  
Erich Kast ◽  
Hans-Peter Richter ◽  
Klaus Mohr
Keyword(s):  
Conservative Management ◽  
Screw Fixation ◽  
The Elderly ◽  
Odontoid Fracture ◽  
High Rate ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Group 2 ◽  
Rate Of Failure ◽  
Group 1

Abstract OBJECTIVE Optimal treatment of elderly patients with Type II odontoid fractures is controversial. Suggestions vary between conservative management and different types of early surgery. Recent data confirm that early surgery may be warranted because conservative treatment has a high rate of failure in the elderly. METHODS We performed a case-control study of 27 patients with Type II odontoid fracture who were treated with anterior odontoid double-screw fixation at our institution. The aim of the study was to determine whether patients aged 70 years or older have a less favorable outcome than younger patients with this operative technique. Cases were defined as patients with Type II odontoid fracture aged 70 years or older. All patients younger than 70 years served as controls. RESULTS There were 15 patients aged 70 years or older (Group 1) and 12 patients younger than 70 years of age (Group 2). Mean follow-up was 16.6 months. Mean interval between fracture and surgery was 10 days. All patients were treated with anterior odontoid screw fixation by use of two compression screws. Fusion rates were 73% in Group 1 and 75% in Group 2. Additional dorsal stabilization was performed in 13% of cases in Group 1 and 17% of cases in Group 2. Complications occurred in 20% of cases in Group 1 and 8% of cases in Group 2. The only death occurred in Group 1, leading to 7% mortality in this group. Neurological status at admission and after treatment was similar in both groups. Statistical analysis did not reveal significant differences between groups for the factors studied. CONCLUSION Outcome after anterior odontoid screw fixation is not affected by patient age. Slightly higher rates of medical complications did not reach statistical significance. Because conservative management of odontoid fractures in the elderly has a high rate of failure, anterior stabilization for Type II odontoid fractures can be recommended.

P155. Clinical outcomes of conservatively managed type II odontoid fractures in older people

2019 ◽  
Vol 19 (9) ◽  
pp. S230
Author(s):  
Suzanne McIlroy ◽  
Jordan Lam ◽  
Gordan Grahovac ◽  
David Bell
Keyword(s):  
Older People ◽  
Clinical Outcomes ◽  
Type Ii ◽  
Odontoid Fractures

Surgical Treatment of Unstable Type II Odontoid Fractures in Skeletally Mature Individuals

Spine ◽  
2010 ◽  
Vol 35 (Supplement) ◽  
pp. S209-S218 ◽  
Author(s):  
Alpesh A. Patel ◽  
Ron Lindsey ◽  
Jason T. Bessey ◽  
Jens Chapman ◽  
Raja Rampersaud
Keyword(s):  
Surgical Treatment ◽  
Type Ii ◽  
Odontoid Fractures ◽  
Unstable Type

scholarly journals Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population

Medicine ◽  
2019 ◽  
Vol 98 (44) ◽  
pp. e10281 ◽  
Author(s):  
Lei Fan ◽  
Dingqiang Ou ◽  
Xuna Huang ◽  
Mao Pang ◽  
Xiu-Xing Chen ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Type Ii ◽  
Geriatric Population ◽  
Odontoid Fractures

Anterior fixation of odontoid fractures in an elderly population

2010 ◽  
Vol 12 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Andrew T. Dailey ◽  
David Hart ◽  
Michael A. Finn ◽  
Meic H. Schmidt ◽  
Ronald I. Apfelbaum
Keyword(s):  
Elderly Population ◽  
Odontoid Process ◽  
Feeding Tube ◽  
Type Ii ◽  
Single Institution ◽  
Odontoid Fractures ◽  
Single Screw ◽  
Flexion Extension ◽  
Fracture Nonunion

Object Fractures of the odontoid process are the most common fractures of the cervical spine in patients over the age of 70 years. The incidence of fracture nonunion in this population has been estimated to be 20-fold greater than that in patients under the age of 50 years if surgical stabilization is not used. Anterior and posterior approaches have both been advocated, with excellent results reported, but surgeons should understand the drawbacks of the various techniques before employing them in clinical practice. Methods A retrospective review was undertaken to identify patients who had direct fixation of an odontoid fracture at a single institution from 1991 to 2006. Patients were followed up using flexion-extension radiographs, and stability was evaluated as bone union, fibrous union, or nonunion. Patients with bone or fibrous union were classified as stable. In addition, the incidence of procedure- and nonprocedure-related complications was extracted from the medical record. Results Of the 57 patients over age 70 who underwent placement of an odontoid screw, 42 underwent follow-up from 3 to 62 months (mean 15 months). Stability was confirmed in 81% of these patients. In patients with fixation using 2 screws, 96% demonstrated stability on radiographs at final follow-up. Only 56% of patients with fixation using a single screw demonstrated stability on radiographs. In the immediate postoperative period, 25% of patients required a feeding tube and 19% had aspiration pneumonia that required antibiotic treatment. Conclusions Direct fixation of Type II odontoid fractures showed stability rates > 80% in this challenging population. Significantly higher stabilization rates were achieved when 2 screws were placed. The anterior approach was associated with a relatively high dysphagia rate, and patients must be counseled about this risk before surgery.

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