The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review

Abstract

Purpose Odontoid fractures are the most common cervical spine fractures in the elderly. As the population ages, their incidence is expected to increase progressively. The optimal treatment of this condition is still the subject of controversy. The objective of this review is to summarize and compare the outcome of surgical and conservative interventions in the elderly (C65 years). Methods A comprehensive search was conducted in nine databases of medical literature, supplemented by reference and citation tracking. Clinical status was considered the primary outcome. Fracture union and stability rates were considered secondary outcomes. Results A total of nineteen studies met the inclusion criteria. All studies were performed retrospectively and were of limited quality. There was insufficient data, especially from direct comparisons, to determine the difference in clinical outcome between surgical and conservative interventions. Osseous union was achieved in 66-85 % of surgically treated patients and in 28-44 % of conservatively treated patients. Fracture stability was achieved in 82-97 % of surgically patients and in 53-79 % of conservatively treated patients. Conclusions There was insufficient data to determine a potential difference in clinical outcome between different treatment groups. Surgically treated patients showed higher osseous union rates compared to conservatively treated patients, possibly because of different selection mechanisms. The majority of patients appears to achieve fracture stability regardless of the applied treatment. A prospective trial with appropriate sample size is needed to identify the optimal treatment of odontoid fractures in the elderly and predictors for the success of either one of the available treatments.

Odontoid balloon kyphoplasty associated with screw fixation for Type II fracture in 2 elderly patients

“…Three well-conducted reviews of the literature 20,34 do not arrive at any endorsement regarding the treatment of choice, orthopedic or surgical, and in terms of surgery, regarding posterior or anterior fixation. The various articles reviewed are all retrospective analyses of small cohorts, with assessment lacking for certain ones, and especially great variation in the evaluation scoring among the series and the follow-up period.…”

“…Type II is the most common, the most unstable, and the one most at risk for pseudarthrosis. 2,20,48 Type III is second in terms of frequency and is generally stable. Type I is stable and extremely uncommon.…”

“…20,33,34 Surgical and orthopedic treatments are regularly compared. Each is associated with a certain number of failures, morbidity, and mortality.…”

Treatment of Anderson Type II Odontoid Fracture in Elderly Patients by Posterior Pedicle Screw Fixation Combined with Iliac Bone Grafting

“…Elderly odontoid fractures in patients with no surgical treatment, only give conservative treatment (such as strict relax on bed, line Halo-vest external fixation, etc.). The fracture healing rate of odontoid fracture can up to 50% -80% [2], and may be caused by the relevant serious complications due to atlantoaxial instability, so most scholars consider that the vast majority of elderly odontoid fractures need to be given surgical diagnosis and treatment [3]; but for the elderly odontoid fracture, there is still more controversy of the choice of surgical methods [4]. There are many kinds of internal fixation methods, such as posterior lateral mass screw fixation (Magerl operation), posterior lateral mass screw fixation (Apofix operation), Brooks posterior wire fixation, Halifax posterior laminectomy and so on.…”

Comparison of Surgical and Conservative Treatments for Odontoid Fractures in the Elderly: Results from Three Tertiary Referral Centers in the Netherlands

“…Recent literature reviews on this topic were inconclusive, due to limited quantity and quality of the available data [5,11,12]. Recent clinical studies focused on survival and complications, but not on union, stability or clinical outcome [13,14].…”