Introduction: Odontoid fractures are common cervical spine fractures in the elderly and represent a significant management challenge with widely divergent views regarding the utility of operative vs non-operative management.
Methods: 159 patients with radiographically confirmed Type II odontoid fracture were enrolled in this prospective study at 11 North American sites. Subjects were followed prospectively at 6 and 12 months post initial treatment with Neck Disability Index (NDI) and SF36v2 scores. Plain radiographs (anteroposterior, lateral and open-mouth views) were also performed to assess fracture union. Final treatment outcome was classified as Failure (F) or Success (S) by the following pre-determined criteria. Failure of the treatment was defined if any of the following was true: 1) subject died, regardless of cause of death; 2) NDI declined by more than 9.5 (literature based clinically significant difference); 3) subject experienced a major complication. Baseline characteristics between the “F” and “S” groups were compared by t-test for the continuous variables and chi-square test for the categorical variables. The characteristics associated with treatment outcomes were identified by multiple logistic regression analysis. All analyses were performed in SAS 9.3.
Results: 101 patients were treated surgically and 58 conservatively. Seventy-three (45.9%) patients were deemed to have a successful outcome and 86 (54.1%) had a failure according the pre-determined criteria. Twenty-nine patients (18.1%) expired before reaching 12-months follow-up and 3 withdrew from the study. Follow-up information was available for 103 out of 130 surviving patients (81.1%). Twelve months SF36v2 scores were worse in the failure group compared to the successful group. The characteristics associated with treatment failure were older age (OR = 1.05 for each year of age); initial conservative treatment (OR = 2.92); and baseline neurologic system comorbidity (OR = 4.13.
Conclusions: Neurologic compromise, increasing age and non-surgical treatment are associated with failure of treatment in patients with geriatric odontoid fractures.
Patient Care: By identifying patient and treatment characteristics associated with treatment success or failure using rigorous pre-determined criteria.
Learning Objectives: The learning objectives for this study are to identify patient and treatment characteristics associated with treatment success or failure using rigorous pre-determined criteria.