Conservative management of type II and III odontoid fractures in the elderly at a regional spine centre: A prospective and retrospective cohort study

Patel, Amit; Zakaria, Rasheed; Al-Mahfoudh, Rafid; Clark, Simon; Barrett, Chris; Sarsam, Zaid; Pillay, Robin; Pigott, Tim; Wilby, Martin

doi:10.3109/02688697.2014.958055

Cited by 46 publications

(51 citation statements)

References 17 publications

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“…[17] Hard cervical collar may be a more appropriate treatment option, as lower rates of respiratory complications have been reported [19]. Polin et al and Patel et al have reviewed their single-center experiences comparing halo-vest with rigid cervical collar for immobilization of both type II and III odontoid fractures [18,20]. Halo-vest was not found superior to hard cervical collar immobilization for these fracture types, leading them to recommend hard collars, which do not carry the risks associated with halo-vests.…”

Section: Nonoperative Managementmentioning

confidence: 99%

“…These results are supported by the GOF study, where nonunions were more common following halo-vest treatment than hard collar treatment. Patel et al and others have noted that a solid union is not necessary to achieve good outcomes with type II odontoid fractures and that a fibrous nonunion can offer good outcomes [20,21]. Nonunions are a concern with nonoperative management of type II odontoid fractures, however, as pain and instability can lead to delayed surgical management [22••].…”

Section: Nonoperative Managementmentioning

confidence: 99%

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Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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Fractures of the second cervical vertebra (C2, axis) are common in adult spine surgery. Those fractures occurring in younger adult patients are often associated with highenergy mechanism trauma, resulting in a "Hangman's Fracture." Management of these fractures is often successful with nonoperative means, though surgery may be needed in those fractures with greater displacement and injury to the C2-C3 disc. Older patients are more likely to sustain fractures of the odontoid process. The evidence supporting surgical management of these fractures is evolving, as there may be a mortality benefit to surgery. Regardless of treatment, longerterm mortality rates are high in this patient population, which should be discussed with the patient and family at the time of injury. Pediatric patients may suffer fractures of the axis, though differentiation of normal and pathologic findings is necessary and more difficult with the skeletally immature spine.

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Section: Nonoperative Managementmentioning

confidence: 99%

Section: Nonoperative Managementmentioning

confidence: 99%

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Gornet

Kelly

2016

Curr Rev Musculoskelet Med

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“…We treated odontoid fracture patients (1 in type I, 4 in type IIA, and 23 in type III) with immobilization as Grauer’s classification recommendation. In our cases, union rate is relatively higher (over than 85%) although several papers have high nonunion rate (13%–72%) with immobilization13,14). Generally, external immobilization is contraindicated because of low bone density, decreased blood supply, etc 7)…”

Section: Discussionmentioning

confidence: 59%

Clinical Results of Odontoid Fractures according to a Modified, Treatment-Oriented Classification

Cho

Kim

et al. 2017

Korean J Spine

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ObjectiveOdontoid fracture is common in cervical injury, representing about 20% of total cervical fractures. Classic odontoid fracture classification focused on anatomy of fracture site has no treatment recommendation and a modified treatment-oriented classification of odontoid fracture was suggested in 2005. We reviewed our odontoid fracture patients to assess the feasibility and efficacy of Grauer’s classification.MethodsBetween October 2000 and September 2015, we collected data from patients who came to our institute for odontoid fracture. Demographic data of patients was reviewed, and neck visual analog scale (VAS) score and fusion rate were assessed by reviewing electronic medical records retrospectively.ResultsSixty-nine patients out of a total of eighty two odontoid fracture patients were reviewed according to Grauer’s classification. Neck VAS of all subtypes in odontoid fracture classification were decreased at last follow-up (p=0.001). Overall fusion rate was 88.4% at last follow-up. Concordance rate between Grauer’s recommendation and our treatment was 69.9%, especially in type II with the concordance higher than 80%. Complication was minimal representing 7.2%, only in types I and III.ConclusionIn this study, there were statistically significant improvement in all subtypes in terms of neck VAS at the last follow up, especially in types II and III. Grauer’s classification appears to be meaningful to decide treatment plan for odontoid fractures, especially type II odontoid fracture.

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“…Befürchtet wird häufig eine durch eine Pseudarthrose persistierende Instabilität mit konsekutiver Stenosierung bzw. einer resultierenden Myelopathie mit neurologischen Beeinträchtigungen [8,19].…”

Section: Relevanz Der Pseudarthroseunclassified

“…Nachteile der Haloimmobilisation sind die signifikant erhöhten lokalen (Pininfekt, Lockerung, Liquorleckage) und systemischen (Pneumonie, kardiovaskuläre Komplikationen) Komplikationsraten [2,8,17,23]. Wird heute noch über die Anwendung des Halo diskutiert, wird eher auf jüngere Patienten abgestellt [19,23].…”

Section: Konservative Möglichkeitenunclassified

Geriatrische Dens-Fraktur – Konservative Therapie

Heyde

2018

Die Wirbelsäule

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ZusammenfassungDie Therapie geriatrischer Densfrakturen, insbesondere des Typ II nach Anderson und D’Alonzo, wird nach wie vor kontrovers diskutiert. Aktuelle Reviews und erste prospektive Studiendaten legen Vorteile der operativen Versorgung, vor allem in Bezug auf die Mortalitätsrate, nahe.Eine kritische Würdigung der zur Verfügung stehenden Daten der aktuellen Literatur führt jedoch zu Ergebnissen, welche eine vorsichtige Interpretation dieser Daten nahelegen und einen weiterhin hohen Stellenwert der konservativen Therapie aufzeigen.Die Komplikationsrate beider Vorgehensweisen – operativ versus konservativ – ist vergleichbar. Die konservative Therapie ist mit einer höheren Pseudarthroserate verbunden. Allerdings wird das Erreichen einer fibrösen Steife auch als Therapieerfolg angesehen und der klinische Stellenwert der Pseudarthrose verbleibt unklar. Die Datenlage in Bezug auf die Mortalität ist nach wie vor, auch in Reviews und Metaanalysen, inkonsistent. Während bei Patienten zwischen 65 bis 80 – 85 Jahre die Mortalität nach konservativer Versorgung höher zu sein scheint, gibt es Arbeiten, die bei Patienten ab 80 – 85 Jahren eine Aufhebung dieser Unterschiede und in dieser Altersklasse generell Vorteile der konservativen Therapie sehen.Das zentrale Problem der aktuell zur Verfügung stehenden Literatur, auch der vorliegenden prospektiven aber nicht randomisierten Daten besteht in dem Selektionsbias und damit in der fehlenden wirklichen Vergleichbarkeit der analysierten Patientenkohorten.Somit konnte bis zum jetzigen Zeitpunkt keine wirkliche Überlegenheit einer der beiden Therapieformen aufgezeigt werden. Damit hat die konservative Therapie ihren Stellenwert und muss in die therapeutischen Überlegungen gleichberechtigt einbezogen werden.

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Conservative management of type II and III odontoid fractures in the elderly at a regional spine centre: A prospective and retrospective cohort study

Cited by 46 publications

References 17 publications

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Fractures of the axis: a review of pediatric, adult, and geriatric injuries

Clinical Results of Odontoid Fractures according to a Modified, Treatment-Oriented Classification

Geriatrische Dens-Fraktur – Konservative Therapie

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