Odontoid Fractures With Neurologic Deficit Have Higher Mortality and Morbidity

Patel, Amar; Smith, Harvey E.; Radcliff, Kris; Yadlapalli, Navin K.; Vaccaro, Alexander R.

doi:10.1007/s11999-011-1994-8

Cited by 30 publications

(13 citation statements)

References 20 publications

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“…In the full text of the included publications mortality data was identified and added to a cumulative database. In 29 articles mortality data from 1284 cases was available [ 3 , 5 , 6 , 11 – 15 , 18 – 21 , 24 – 27 , 31 – 36 , 41 – 44 , 46 , 50 ]. If a patient characteristics chart was available, survival, follow-up, patient age, and treatment allocated were added directly to the database for each patient.…”

Section: Resultsmentioning

confidence: 99%

“…Other factors than treatment modality seem to play a greater role for patient survival. Patel et al [ 50 ] found in their investigation of 20 elderly patients with type II odontoid fractures associated with neurological deficit a higher mortality (RR = 4.7; 95% CI: 1.4–16.6) than in neurologically intact patients ( n = 188); in patients with complete tetraparesis ( n = 11) the risk was even higher (RR = 9.3; 95% CI: 1.2–73.0).…”

Section: Discussionmentioning

confidence: 99%

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Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

Robinson

Olerud

2014

BioMed Research International

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Odontoid fractures type II according to Anderson and d'Alonzo are not uncommon in the elderly patients. Still, due to the paucity of evidence the published treatment guidelines are far from equivocal. This systematic review focuses on the published results of type II odontoid fracture treatment in the elderly with regard to survival, nonunion, and complications. After a systematic literature research 38 publications were included. A cumulative analysis of 1284 published cases found greater survival if elderly patients with odontoid fractures type II received surgical treatment (RR = 0.64). With regard to nonunion in 669 published cases primary posterior fusion had the best fusion results. The systematic literature review came to the following conclusions. (1) Surgical stabilisation of odontoid fractures type II improves survival in patients between 65 and 85 years of age compared to nonsurgical treatment. (2) Posterior atlantoaxial fusion for odontoid fractures type II in the elderly has the greatest bony union rate. (3) Odontoid nonunion is not associated with worse clinical or functional results in the elderly. (4) The complication rate of nonsurgical treatment is similar to the complication rate of surgical treatment of odontoid fractures type II in the elderly.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

Robinson

Olerud

2014

BioMed Research International

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“…Some literature raises the concern that myelopathy may develop in patients with odontoid fracture and with odontoid nonunion. 40 , 53 – 56 In a retrospective institution database search by Patel et al, 57 it was found that neurologic deficit with type II odontoid fracture was as high as 9.6%. Kepler et al 56 performed a retrospective case series of 133 consecutive patients over a 5-year period with type II odontoid fractures.…”

Section: Discussionmentioning

confidence: 99%

Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion

Raudenbush

Molinari

2015

Geriatr Orthop Surg Rehabil

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Introduction:Longer-term outcomes of patients with geriatric type II odontoid fracture nonunion remain unclear.Methods:Thirty-four consecutive geriatric patients (>70 years old) with minimally displaced (<50% displacement) type II odontoid fractures were treated 24 hours a day for 12 weeks with rigid collar immobilization between the years 2003 and 2011. Radiographic and medical record reviews were performed on all 34 patients. Additionally, 7 patients were available for clinical longer-term follow-up (>4 years).Results:In all, 30 (88%) of the 34 patients had nonunion after 12 weeks of treatment, 2 (6%) patients had union, and 2 (6%) patients died during the first 12 weeks. Twenty-one of the 30 patients with nonunion had a displaced or mobile nonunion (70%), and 4 (12%) patients were lost to follow-up. At longer-term follow-up, 23 (68%) patients had died. The average time death occurred was 3.8 years with a range of 0.17 years to 9.42 years postinjury. Twenty of the 23 deaths were attributed to medical comorbidities not related to the patient’s odontoid nonunion. We were unable to determine the cause of death in 3 patients. None of the patients who died had identifiable clinical myelopathy prior to their death on chart review. Of the 7 patients who were alive, all were determined to have odontoid nonunion, of which 5 (70%) were mobile odontoid nonunion. Visual Analog Scale (VAS) and Neck Disability Index (NDI) scores were low (VAS averaged 0.57 and NDI averaged 6.9%) and treatment satisfaction was high (averaged 9.7 of 10). Scores for pain and function did not differ significantly when compared to age-matched controls (P = .08, t test).Conclusion:Rates of odontoid nonunion are high in patients with geriatric odontoid fractures that are treated with continuous rigid collar for 12 weeks. The majority of patients with nonunion appear to achieve high functional outcomes. In this study, mortality did not appear to be related to adverse neurologic events after treatment.

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“…Cette proportion semble faible comparée aux données de certaines publications. Récemment, Patel retrouvait 9,6 % de déficits neurologiques associés aux fractures de l'odontoïde tous âges confondus (42-89 ans) avec une mortalité associée élevée puisque 50 % étaient décédés dans les trois premiers mois [50].…”

Section: Discussionunclassified

Complications des traumatismes du rachis cervical supérieur chez les sujets âgés. Revue systématique de la littérature

Jubert

Lonjon

Loubresse

et al. 2013

Revue de Chirurgie Orthopédique et Traumatologique

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Odontoid Fractures With Neurologic Deficit Have Higher Mortality and Morbidity

Abstract: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 30 publications

References 20 publications

Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

Systematic Review on Surgical and Nonsurgical Treatment of Type II Odontoid Fractures in the Elderly

Longer-Term Outcomes of Geriatric Odontoid Fracture Nonunion

Complications des traumatismes du rachis cervical supérieur chez les sujets âgés. Revue systématique de la littérature

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