Fusion rates for conservative and surgical management of type II odontoid fractures and its impact

Harris, Lauren; Arif, Shahswar; Elliot, Matthew; Brady, Zarina; Lawrence, Alistair J.; Lee, Cheong; Tsang, Kevin

doi:10.1080/02688697.2021.1926921

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…Fracture due to low-impact mechanism indicates bone fragility and patient frailty [12]. In a relatively large cohort of 92 patients treated with external immobilization published by Harris et al, two asymptomatic patients were offered surgery on the basis of radiological instability but declined and neither report any on-going symptoms [19].…”

Section: Research Resultsmentioning

confidence: 99%

The Significance of Nonunion in Type Ii Odontoid Fracture Treatment

Jurgaitis,

Jukna

2024

Health Sciences

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The second type of dens fracture, according to the Anderson and D’Alonzo classification, is the most prevalent among the three types, accounting for 60-80% of all cases. It is characterized by instability, and the fracture line extends to the base of the odontoid process. Type II fractures can be managed through conservative approaches involving both rigid and non-rigid immobilization or through surgical intervention. When treated conservatively, the rate of nonunion ranges from 50-85%, which decreases to 10-30% when surgical treatment is administered. There is no united consensus on the primary objective of treating Type II odontoid fractures. Some authors debate whether the goal should be achieving osseous union, ensuring fracture stability, or improving clinical outcomes. Certain studies suggest that the frequent complications associated with surgical treatment, without a proven survival benefit, indicate that most patients may be better off with conservative management. On average, around 9.9% of patients shift from non-operative to surgical intervention due to several factors, including radiological findings, with the aim of averting the occurrence of future pain or neurological complications. While it is generally accepted worldwide to surgically treat patients with unstable nonunion, persistent neck pain, or neurological symptoms, there is no consensus on how to manage stable nonunion or even asymptomatic nonunion. Recent research studies suggest that radiologically stable nonunion, in the absence of persistent neck pain and neurological symptoms, might be a satisfactory outcome for patients aged 65 and older.

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Section: Research Resultsmentioning

confidence: 99%

The Significance of Nonunion in Type Ii Odontoid Fracture Treatment

Jurgaitis,

Jukna

2024

Health Sciences

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“…1 Surgical intervention is risky in this population, 1 but conservative management is associated with high rates of fracture nonunion. [2][3][4][5] Moreover, existing literature suggests a substantial rate of delayed morbidity associated with nonoperative management. [6][7][8][9] Indeed, a recent meta-analysis showed a trend toward significance for a mortality benefit with surgical stabilization.…”

mentioning

confidence: 99%

Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis

Cloney¹,

Thirunavu²,

Roumeliotis³

et al. 2023

Neurosurgery

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BACKGROUND: Existing literature suggests that surgical intervention for odontoid fractures is beneficial but often does not control for known confounding factors. OBJECTIVE: To examine the effect of surgical fixation on myelopathy, fracture nonunion, and mortality after traumatic odontoid fractures. METHODS: We analyzed all traumatic odontoid fractures managed at our institution between 2010 and 2020. Ordinal multivariable logistic regression was used to identify factors associated with myelopathy severity at follow-up. Propensity score analysis was used to test the treatment effect of surgery on nonunion and mortality. RESULTS: Three hundred and three patients with traumatic odontoid fracture were identified, of whom 21.6% underwent surgical stabilization. After propensity score matching, populations were well balanced across all analyses (Rubin's B < 25.0, 0.5 < Rubin's R < 2.0). Controlling for age and fracture angulation, type, comminution, and displacement, the overall rate of nonunion was lower in the surgical group (39.7% vs 57.3%, average treatment effect [ATE] = −0.153 [−0.279, −0.028], P = .017). Controlling for age, sex, Nurick score, Charlson Comorbidity Index, Injury Severity Score, and selection for intensive care unit admission, the mortality rate was lower for the surgical group at 30 days (1.7% vs 13.8%, ATE = −0.101 [−0.172, −0.030], P = .005) and at 1 year was 7.0% vs 23.7%, ATE = −0.099 [−0.181, −0.017], P = .018. Cox proportional hazards analysis also demonstrated a mortality benefit for surgery (hazard ratio = 0.587 [0.426, 0.799], P = .0009). Patients who underwent surgery were less likely to have worse myelopathy scores at follow-up (odds ratio = 0.48 [0.25, 0.93], P = .029). CONCLUSION: Surgical stabilization is associated with better myelopathy scores at follow-up and causes lower rates of fracture nonunion, 30-day mortality, and 1-year mortality.

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“…Dementsprechend ist die Halo-Fixierung im älteren Patientengut praktisch verschwunden und durch semirigide HWS-Orthesen ersetzt worden, die eine sehr geringe Morbidität aufweisen. Typischerweise wird die externe Immobilisation für 12 Wochen empfohlen, wobei dies ebenfalls zu, wenn auch wenig dramatischen, Komplikationen im Sinne von Schmerzen, Steifheit und Nicht-Toleranz in einem Drittel der PatientInnen führt [5].…”

Section: Introductionunclassified

Operative Versorgung der Typ2-Densfraktur bei >80 Jahren – Contra

Thomé

2023

Die Wirbelsäule

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ZusammenfassungDie Versorgung der Typ 2-Densfraktur bei alten PatientInnen wird anhaltend intensiv diskutiert und die Studienlage ist uneinheitlich. Bei weniger alten PatientInnen und bei Frakturen mit ausgeprägter Dislokation oder neurologischen Defiziten wird eine operative Therapie mittels dorsaler HWK 1/2-Instrumentation empfohlen. Die große Mehrzahl der PatientInnen jedoch zeigt nach konservativer Therapie mit einer semirigiden Orthese für 12 Wochen ein klinisch hervorragendes Ergebnis und das Auftreten neuer neurologischer Defizite ist eine Rarität. Die Reoperationsrate nach primär chirurgischer Versorgung ist vergleichbar zur Notwendigkeit einer sekundären Operation aufgrund eines Versagens der konservativen Therapie. Auch wenn ohne Instrumentation nur in ca. 40% der Fälle eine knöcherne Fusion eintritt, korreliert eine Pseudoarthrose nicht mit Beschwerden.

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Fusion rates for conservative and surgical management of type II odontoid fractures and its impact

Cited by 6 publications

References 40 publications

The Significance of Nonunion in Type Ii Odontoid Fracture Treatment

The Significance of Nonunion in Type Ii Odontoid Fracture Treatment

Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis

Operative Versorgung der Typ2-Densfraktur bei >80 Jahren – Contra

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