Management and long-term outcome of type II acute odontoid fractures: a population-based consecutive series of 282 patients

Rizvi, Syed Ali Mujtaba; Helseth, Eirik; Harr, Marianne Efskind; Mirzamohammadi, Jalal; Rønning, Pål; Mejlænder-Evjensvold, Magnus; Linnerud, Hege

doi:10.1016/j.spinee.2020.11.012

Cited by 15 publications

(14 citation statements)

References 34 publications

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“…Surgical fixation has previously been recommended for type II odontoid fractures. We have recently documented that most of these patients can be managed with external immobilization alone, thereby avoiding a surgical procedure associated with high risk in frail older people (Rizvi et al 2021a(Rizvi et al , 2021b(Rizvi et al , 2020.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of traumatic cervical spinal fractures in a general Norwegian population

et al. 2022

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Background In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health-care planning and injury prevention. Methods This is a population-based retrospective database study (with prospectively collected data) from the Southeast Norway health region with 3.0 million inhabitants. We included all consecutive cases diagnosed with a CS-Fx between 2015 and 2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented. Results We registered 2153 consecutive cases with CS-Fx during a 5-year period, with an overall crude incidence of CS-Fx of 14.9/100,000 person-years. Age-adjusted incidences using the standard population for Europe and the World was 15.6/100,000 person-years and 10.4/100,000 person-years, respectively. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%), and four-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%). Conclusions This study provides an overview of the extent of the issue and patient complexity necessary for planning the health-care management and injury prevention of CS-Fx. The typical CS-Fx patient was an elderly male or female with significant comorbidities injured in a low-energy trauma. The overall crude incidences of CS-Fx and surgical fixation of CS-Fx in Southeast Norway were 14.9/100,000 person-years and 3.7/100,000 person-years, respectively.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of traumatic cervical spinal fractures in a general Norwegian population

et al. 2022

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“…Fibrous unions are regarded sufficiently stable and often asymptomatic thereby posing reasonable treatment goal in the high surgical risk population. 6,27,28 Conservative treatment may therefore save the patient from perioperative morbidity when appropriately indicated.…”

Section: Discussionmentioning

confidence: 99%

A Predictive Model to Identify Treatment-related Risk Factors for Odontoid Fracture Nonunion Using Machine Learning

Leister

Haider

Vogel

et al. 2022

Spine

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Study Design. Multicenter retrospective analysis of routinely collected data. Objective. The underlying aim of this study was to identify potential treatment-related risk factors for odontoid fracture nonunion while accounting for known patient- and injury-related risk factors. Summary of Background Data. Type II and III odontoid fractures represent the most common cervical spine fracture in elderly patients and are associated with a relatively high nonunion rate. The management of odontoid fractures is controversial and treatment strategies range from conservative treatment to extensive surgical stabilization and fusion. Methods. A total of 415 individuals who sustained odontoid fracture and were treated in either of four tertiary referral centers in Austria and Germany were included in the study. We included the following potential contributing factors for fracture nonunion in cross-validated extreme gradient boosted (XGBoost) and binary logistic regression models: age, gender, fracture displacement, mechanism of injury (high vs. low energy), fracture classification (Anderson II vs. III), presence of comorbidities (Charlson comorbidity index), and treatment (conservative, anterior screw fixation with one or two screws, posterior C1/C2 spondylodesis, cervico-occipital C0–C4 fusion). Results. In our cohort, 187 (45%) had radiologically confirmed odontoid nonunion six months postinjury. The odds for nonunion increase significantly with age, and are lower in type III compared to type II fractures. Also, odds for nonunion are significantly lower in posterior C1/C2 spondylodesis, and C0–C4 fusion compared to conservative treatment. Importantly, odds are not statistically significantly lower in the group treated with anterior screw fixation compared to conservative treatment. The factors gender, fracture displacement, mechanism of injury, and the presence of comorbidities did not produce significant odds. Conclusion. Higher age, type II fractures, and conservative treatment are the main risk factors for odontoid nonunion. Anterior screw fixation did not differ significantly from conservative treatment in terms of fracture union. Level of Evidence. 3.

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“…Surgical xation has previously been recommended for type II odontoid fractures. We have recently documented that most of these patients can be managed with external immobilization alone, thereby avoiding a surgical procedure associated with high risk in frail older people [20][21][22].…”

Section: Discussionmentioning

confidence: 99%

“…As mentioned above, we have recently documented that most frail old patients with C2 odontoid Fx can be managed with external immobilization alone, thereby avoiding a surgical procedure associated with high risk in frail older people [20][21][22]. However, injury preventive measures must be implemented to reduce the mortality rate signi cantly, e.g., fall prevention measures in the elderly.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Traumatic Cervical Spinal Fractures in a General Western Population

Utheim

Helseth

Stroem

et al. 2021

Preprint

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Background: In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health care planning and injury prevention.Methods: This is a population-based clinical observational cohort study from the southeastern region of Norway with 3.0 million inhabitants. We included all patients diagnosed with a CS-Fx between 2015 and –2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented.Results: We registered 2153 patients with CS-Fx during a 5-years period, with an incidence of CS-Fx of 14.9/100,000 person-years. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%) and 4-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%).Conclusions: This study provides an overview of the extend of the issue and patient complexity necessary for planning the health care management and injury prevention of CS-Fx. We suggest intensified fall preventive measures in the elderly, better public awareness of the risks of excessive ethanol use, and better road safety for bicyclists.

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Management and long-term outcome of type II acute odontoid fractures: a population-based consecutive series of 282 patients

Cited by 15 publications

References 34 publications

Epidemiology of traumatic cervical spinal fractures in a general Norwegian population

Epidemiology of traumatic cervical spinal fractures in a general Norwegian population

A Predictive Model to Identify Treatment-related Risk Factors for Odontoid Fracture Nonunion Using Machine Learning

Epidemiology of Traumatic Cervical Spinal Fractures in a General Western Population

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