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

Abstract

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.

Anterior transarticular atlantoaxial screw fixation in combination with dens screw fixation for type II odontoid fractures with associated atlanto-odontoid osteoarthritis

“…Generally, it is important to note that many studies or reviews in the literature consist of rather small samples or small original study populations [8,26,30,31]. To the best of our knowledge, this series represents the largest study investigating mortality in patients aged 70 years and older with type II odontoid fractures treated with TAFOF.…”

“…However, controversies exist regarding the ideal treatment strategy for elderly patients, particularly those with verified atlanto-odontoid osteoarthritis (AO) [4,5]. For this patient population, conservative therapy strategies are associated with an increased mortality, a high non-union rate, and inferior quality of life [6][7][8][9]. Also, unacceptable complication rates are reported after halo fixator treatment [10].…”

Cost Effectiveness of Operative Versus Non-Operative Treatment of Geriatric Type-II Odontoid Fracture

“…Another possibility is that these studies were simply underpowered to detect the mortality difference, and a meta-analysis including these studies did demonstrate a significant survival advantage associated with surgery. 39 The true reduction in mortality that can be attributed to surgery will probably remain unknown until a randomized-controlled trial on the topic can be performed.…”

Surgical treatment of Type II odontoid fractures: anterior odontoid screw fixation or posterior cervical instrumented fusion?

“…Nonsurgical treatment with a cervical collar or halo vest has a nonunion rate of as high as 40%. 31 For this reason, surgical treatment is especially indicated in patients who have a higher risk for nonunion. In this context, surgical treatment with AOSF or posterior cervical instrumented fusion (PCIF) increases the fusion rate to more than 80% in many patient series.…”

“…In this context, surgical treatment with AOSF or posterior cervical instrumented fusion (PCIF) increases the fusion rate to more than 80% in many patient series. 1,31 Some authors have reported up to 100% healing with posterior C1-2 arthrodesis with PCIF.…”