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Bao X, Chen Y, Guo C, Xu S. Comparison of anterior and posterior approaches in Treating odontoid fractures: a meta-analysis and systematic review. Front Surg 2023; 10:1125665. [PMID: 37377671 PMCID: PMC10291183 DOI: 10.3389/fsurg.2023.1125665] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background Odontoid fractures account for 15%-20% of cervical injuries. Although the operation methods vary in different types, the superiority of overall outcomes of the anterior approach (AA) and posterior approach (PA) in treating odontoid fractures still remains controversial. Thus, a meta-analysis was performed comparing AA and PA for these fractures. Methods The relevant studies were searched in PubMed/MEDLINE, Cochrane Library, EMBASE, China Biological Medicine (CBM), and Wanfang Database from the onset of conception to June 2022. Prospective or retrospective comparative studies on AA and PA for odontoid fractures were screened, referring to fusion rates (primary outcomes), complications, and postoperative mortality rates. A meta-analysis of the primary outcomes and a systematic review of other outcomes were performed; the procedure was conducted with Review Manager 5.3. Results Twelve articles comrising 452 patients were included, and all publications were retrospective cohort studies. The average postoperative fusion rate was 77.5 ± 17.9% and 91.4 ± 13.5% in AA and PA, respectively, with statistical significance [OR = 0.42 (0.22, 0.80), P = 0.009]. Subgroup analysis showed a difference in fusion rates between AA and PA in the elderly group [OR = 0.16 (0.05, 0.49), P = 0.001]. Five articles referred to postoperative mortality, and the mortality rates of AA (5.0%) and PA (2.3%) showed no statistical difference (P = 0.148). Nine studies referred to complications, with a rate of 9.7%. The incidence of complications in AA and PA groups was comparable (P = 0.338), and the incidence of nonfusion and complications was irrelevant. The prevalent cause of death was myocardial infarction. The time and segmental movement retention of AA were possibly superior to those of PA. Conclusion AA may be superior in regard to operation time and motion retention. There was no difference in complications and mortality rates between the two approaches. The posterior approach would be preferred in consideration of the fusion rate.
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Affiliation(s)
- Xianguo Bao
- Spinal Surgery, Nanjing Lishui People’s Hospital, Nanjing, China
| | - Yingjun Chen
- Spinal Surgery, Nanjing Lishui People’s Hospital, Nanjing, China
| | - Chen Guo
- Spinal Surgery, Peking University People’s Hospital, Beijing, China
| | - Shuai Xu
- Spinal Surgery, Peking University People’s Hospital, Beijing, China
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2
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Barrey CY, di Bartolomeo A, Barresi L, Bronsard N, Allia J, Blondel B, Fuentes S, Nicot B, Challier V, Godard J, Marinho P, Kouyoumdjian P, Lleu M, Lonjon N, Freitas E, Berthiller J, Charles YP. C1-C2 Injury: Factors influencing mortality, outcome, and fracture healing. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1574-1584. [PMID: 33635376 DOI: 10.1007/s00586-021-06763-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND C1-C2 injury represents 25-40% of cervical injuries and predominantly occurs in the geriatric population. METHODS A prospective multicentre study was conducted under the aegis of the french spine surgery society (SFCR) investigating the impact of age, comorbidities, lesion type, and treatment option on mortality, complications, and fusion rates. RESULTS A total of 417 patients were recruited from 11 participating centres. The mean ± SD age was 66.6 ± 22 years, and there were 228 men (55%); 5.4% presented a neurological deficit at initial presentation. The most frequent traumatic lesion was C2 fracture (n = 308). Overall mortality was 8.4%; it was 2.3% among those aged ≤ 60 years, 5.0% 61-80 years, and 16.0% > 80 years (p < 0.001). Regarding complications, 17.8% of patients ≤ 70 years of age presented with ≥ 1 complication versus 32.3% > 70 years (p = 0.0009). The type of fracture did not condition the onset of complications and/or mortality (p > 0.05). The presence of a comorbidity was associated with a risk factor for both death (p = 0.0001) and general complication (p = 0.008). Age and comorbidities were found to be independently associated with death (p < 0.005). The frequency of pseudoarthrosis ranged from 0 to 12.5% up to 70 years of age and then constantly and progressively increased to reach 58.6% after 90 years of age. CONCLUSIONS C1-C2 injury represents a serious concern, possibly life-threatening, especially in the elderly. We found a major impact of age and comorbidities on mortality, complications, and pseudarthrosis; injury pattern or treatment option seem to have a minimal effect.
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Affiliation(s)
- C Y Barrey
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 151 Boulevard de l'Hôpital, 75013, Paris, France.
| | - A di Bartolomeo
- Division of Neurosurgery, Department of Neurology and Psychiatry, Sapienza University, Roma, Italy
| | - L Barresi
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - N Bronsard
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - J Allia
- Department of Spine Surgery, Institut Universitaire de L'appareil Locomoteur Et du Sport, CHU de Nice, Hopital Pasteur 2, 30 voie Romaine, 06001, Nice, France
| | - B Blondel
- Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - S Fuentes
- Department of Spine Surgery, CHU Timone, AP-HM, Université Aix-Marseille, 264 rue Saint-Pierre, 13005, Marseille, France
| | - B Nicot
- Department of Neurosurgery, CHU de Grenoble, Avenue Maquis-du-Grésivaudan, 38700, Grenoble-La Tronche, France
| | - V Challier
- Department of Orthopaedic Surgery, Hôpital Tripode, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076, Bordeaux cedex, France
| | - J Godard
- Department of Spine Surgery, Hôpital Jean-Minjoz, 3 boulevard A Fleming, 25030, Besançon, France
| | - P Marinho
- Department of Neurosurgery, Hôpital Roger-Salengro, CHRU de Lille, Rue Emile-Laine, 59037, Lille, France
| | - P Kouyoumdjian
- Department of Orthopaedic Surgery, CHU de Nîmes, Avenue du Pr Debré, 30000, Nîmes, France
| | - M Lleu
- Department of Neurosurgery, CHU de Dijon, 14 rue Paul Gaffarel, 21000, Dijon, France
| | - N Lonjon
- Department of Neurosurgery, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France
| | - E Freitas
- Department of Spine and Spinal Cord Surgery, P Wertheimer University Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 boulevard Pinel, 69003, Lyon, France
| | - J Berthiller
- Department of Biostatistics and Epidemiology, Pôle IMER, Hospices Civils de Lyon, 162 Avenue Lacassagne, 69424, Lyon, France
| | - Y P Charles
- Department of Spine Surgery, Hopitaux Universitaires de Strasbourg, 1 place de l'Hopital, BP 426, 67091, Strasbourg, France
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3
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Dodson BK, Braswell M, David AP, Young JS, Riccio LM, Kim Y, Calland JF. Adult and elderly population access to trauma centers: an ecological analysis evaluating the relationship between injury-related mortality and geographic proximity in the United States in 2010. J Public Health (Oxf) 2019; 40:848-857. [PMID: 29190373 PMCID: PMC6306086 DOI: 10.1093/pubmed/fdx156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/25/2017] [Indexed: 02/06/2023] Open
Abstract
Background Ongoing development and expansion of trauma centers in the United States necessitates empirical analysis of the effect of investment in such resources on population-level health outcomes. Methods Multiple linear regressions were performed to predict state-level trauma-related mortality among adults and the elderly across 50 US states in 2010. The number of trauma centers per capita in each state and the percentage of each state’s population living within 45-min of a trauma center served as the key independent variables and injury-related mortality served as the dependent variable. All analyses were stratified by age (adult versus elderly; elderly ≥ 65 years old) and were performed in SPSS. Results The proportion of a population with geographic proximity to a trauma center demonstrates a consistent inverse linear relationship to injury-related mortality. The relationship reliably retains its significance in models including demographic covariates. Interestingly, access to Levels I and II trauma centers demonstrates a stronger correlation with mortality than was observed with Level III centers. Conclusion Trauma center access is associated with reduced trauma-related mortality among both adults and the elderly as measured by state reported mortality rates. Ongoing efforts to designate and verify new trauma centers, particularly in poorly-served ‘trauma deserts’, could lead to lower mortality for large populations.
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Affiliation(s)
- B K Dodson
- Eastern Virginia Medical School, School of Medicine, Norfolk, VA, USA
| | - M Braswell
- Institute for Advanced Studies in Culture, Charlottesville, VA, USA
| | - A P David
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J S Young
- School of Medicine, Department of Surgery- Division of Acute Care Surgery and Outcomes Research, University of Virginia, Charlottesville, VA, USA
| | - L M Riccio
- Winchester Medical Center, Acute Care Emergency Surgery Services, Winchester, VA, USA
| | - Y Kim
- School of Medicine, Department of Surgery- Division of Acute Care Surgery and Outcomes Research, University of Virginia, Charlottesville, VA, USA
| | - J F Calland
- School of Medicine, Department of Surgery- Division of Acute Care Surgery and Outcomes Research, University of Virginia, Charlottesville, VA, USA
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Gembruch O, Lemonas E, Ahmadipour Y, Sure U, El Hindy N, Dodel R, Müller O. Treatment of Odontoid Type II Fractures in Octogenarians: Balancing Two Different Treatment Strategies. Neurospine 2019; 16:360-367. [PMID: 31154696 PMCID: PMC6603819 DOI: 10.14245/ns.1836250.125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/31/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Demographic changes have led to a higher incidence of C-2 fractures, especially in elderly patients. For patients with type II fractures, treatment remains controversial, as discussed by Anderson and D'Alonzo, due to the rising morbidity and mortality rates for any treatment. The aim of this study was to compare conservative and surgical management in patients with type II C-2 fractures regarding outcomes, complications, and the mortality rate. METHODS A retrospective analysis was performed of the medical records, X-rays, and/or computed tomography scans of patients ≥80 years of age with type II fractures who were admitted to our Department of Neurosurgery between January 1990 and December 2017. The success of treatment was evaluated 3 months after surgery. RESULTS In total, 125 patients were included, of whom 98 were treated surgically and 27 were treated conservatively. Surgical treatment was successful in 90.8% of cases, while conservative treatment was successful in 70.0%. The in-hospital mortality was 14.29% and the 3-month mortality was 27.8% in the surgical group, compared to 3.7% and 20% in the conservatively treated group. The in-hospital complication rate was 22.4% in the surgically treated patients and 7.4% in the conservatively treated patients. CONCLUSION Surgical treatment of type II fractures seemed to be associated with higher success and complication rates than conservative treatment. Nevertheless, 3-month mortality was comparable in both groups. Therefore, we conclude that surgical treatment for type II fractures in elderly patients is superior to conservative management, although conservative treatment remains a valuable option in elderly patients with severe comorbidities.
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Affiliation(s)
- Oliver Gembruch
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Elias Lemonas
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Department of Spine Surgery, Katholisches Klinikum Lünen/Werne GmbH, St. Christophorus-Krankenhaus, Werne, Germany
| | - Richard Dodel
- Department of Geriatric Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,Geriatric Center Haus Berge, Contilia Group, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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5
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Sarode DP, Demetriades AK. Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review. Spine J 2018; 18:1921-1933. [PMID: 29886165 DOI: 10.1016/j.spinee.2018.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/25/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Odontoid process fractures, of which type II constitute the majority, are an increasingly important cause of morbidity and mortality in the elderly population. The incidence of geriatric type II fractures is steadily increasing in line with the aging population. However, the decision between surgical and non-surgical intervention for type II fractures in the elderly remains controversial. PURPOSE The present study aims to synthesize the current published literature comparing outcomes following surgical and non-surgical interventions for type II odontoid fractures in the elderly population (≥65 years old). STUDY DESIGN/SETTING Systematic review and meta-analysis were performed. METHODS A systematic search of MEDLINE, MEDLINE In-Progress & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to identify available evidence in English language. Studies with extractable data for all type II odontoid fractures in participants aged 65 years or older and which compared surgical and non-surgical intervention were included. Methodological quality was assessed using the Downs & Black checklist. Primary outcomes were mortality at short-term follow-up (≤3 months), mortality at long-term follow-up (predetermined study endpoint or mean follow-up length), and radiological union rate. Funding was provided by The University of Edinburgh for travel expenses to present this paper at the Society of British Neurological Sciences 2016 Conference ($170). RESULTS Twelve studies (n=1,098), all non-randomized, met eligibility criteria. Methodological quality was particularly poor in the confounding, bias, and power domains of assessment. Substantial methodological and statistical heterogeneity allowed only a narrative synthesis of the primary outcomes. Overall, data on mortality at short-term follow-up appeared to favor neither surgical nor non-surgical intervention. A small favorable outcome in surgically managed patients over non-surgically managed patients in terms of mortality at long-term follow-up was not proven conclusive because of considerable heterogeneity in study methodologies. Inadequate reporting of the time point of union assessment introduced the potential for significant intra- and interstudy heterogeneity and precluded assessment of union rates. CONCLUSIONS Evidence on this controversial topic is sparse, markedly heterogeneous, and of poor quality. Well-designed prospective trials adhering to guidance published by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative are required to inform clinical practice on this contentious but growing issue. Future randomized controlled trials should include an assessment of frailty and medical comorbidities with suitable patients subsequently randomized to surgical or non-surgical treatment.
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Affiliation(s)
- Deep P Sarode
- College of Medicine and Veterinary Medicine, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom; Edinburgh Spinal Surgery Outcomes Study Group, Department of Clinical Neurosciences, Western General Hospital, Crewe Rd South, Edinburgh EH4 2XU, United Kingdom
| | - Andreas K Demetriades
- College of Medicine and Veterinary Medicine, The University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, United Kingdom; Department of Clinical Neurosciences, Western General Hospital, Crewe Rd South, Edinburgh EH4 2XU, United Kingdom; Edinburgh Spinal Surgery Outcomes Study Group, Department of Clinical Neurosciences, Western General Hospital, Crewe Rd South, Edinburgh EH4 2XU, United Kingdom.
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6
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Robinson AL, Möller A, Robinson Y, Olerud C. C2 Fracture Subtypes, Incidence, and Treatment Allocation Change with Age: A Retrospective Cohort Study of 233 Consecutive Cases. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8321680. [PMID: 28182084 PMCID: PMC5274671 DOI: 10.1155/2017/8321680] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 12/19/2016] [Indexed: 11/17/2022]
Abstract
The currently available data on the distribution of C2 fracture subtypes is sparse. This study was designed to identify the proportions of the second cervical vertebra (C2) fracture subtypes and to present age and gender specific incidences of subgroups. A dataset of all patients treated between 2002 and 2014 for C2 fractures was extracted from the regional hospital information system. C2 fractures were classified into odontoid fractures types 1, 2, and 3, Hangman's fractures types 1, 2, and 3, and atypical C2 fractures. 233 patients (female 51%, age 72 ± 19 years) were treated for a C2 fracture. Odontoid fractures were found in 183 patients, of which 2 were type 1, 127 type 2, and 54 type 3, while 26 of C2 fractures were Hangman's fractures and 24 were atypical C2 fractures. In the geriatric subgroup 89% of all C2 fractures were odontoid, of which 71% were type 2 and 29% type 3. There was an increasing incidence of odontoid fractures types 2 and 3 from 2002 to 2014. 40% of C2 fractures were treated surgically. This study presents reliable subset proportions of C2 fractures in a prospectively collected regional cohort. Knowledge of these proportions facilitates future epidemiological studies of C2 fractures.
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Affiliation(s)
- Anna-Lena Robinson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
- Stockholm Spine Center, Stockholm, Sweden
| | - Anders Möller
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - Yohan Robinson
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Claes Olerud
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
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7
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Schroeder GD, Kepler CK, Kurd MF, Paul JT, Rubenstein RN, Harrop JS, Brodke DS, Chapman JR, Vaccaro AR. A Systematic Review of the Treatment of Geriatric Type II Odontoid Fractures. Neurosurgery 2016; 77 Suppl 4:S6-14. [PMID: 26378359 DOI: 10.1227/neu.0000000000000942] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Odontoid fractures are the most common cervical spine fracture in the geriatric population; however, the treatment of type II odontoid fractures in this age group is controversial. OBJECTIVE To compare the short-term (<3 months) mortality, long-term (≥12 months) mortality, and complication rates of patients >60 years of age with a type II odontoid fracture managed either operatively or nonoperatively. METHODS We performed a systematic review of literature published between January 1, 2000, and February 1, 2015, related to the treatment of type II odontoid fractures in patients >60 years of age. An analysis of short-term mortality, long-term mortality, and the occurrence of complications was performed. RESULTS A total of 452 articles were identified, of which 21 articles with 1233 patients met the inclusion criteria. Short-term mortality (odds ratio, 0.43; 95% confidence interval, 0.30-0.63) and long-term mortality (odds ratio, 0.47; 95% confidence interval, 0.34-0.64) were lower in patients who underwent surgical treatment than in those who had nonsurgical treatment, and there were no significant differences in the rate of complications (odds ratio, 1.01; 95% confidence interval, 0.63-1.63). Surgical approach (posterior vs anterior) showed no significant difference in mortality or complication rate. Similarly, no difference in mortality or complication rate was identified with hard collar or a halo orthosis immobilization. CONCLUSION The current literature suggests that well-selected patients >60 years of age undergoing surgical treatment for a type II odontoid fracture have a decreased risk of short-term and long-term mortality without an increase in the risk of complications.
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Affiliation(s)
- Gregory D Schroeder
- *Rothman Institute at Thomas Jefferson University, Department of Orthopedic Surgery, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania; §Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah; ¶Swedish Neuroscience Institute, Department of Orthopedic Surgery, Seattle, Washington
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Ryang YM, Török E, Janssen I, Reinke A, Buchmann N, Gempt J, Ringel F, Meyer B. Early Morbidity and Mortality in 50 Very Elderly Patients After Posterior Atlantoaxial Fusion for Traumatic Odontoid Fractures. World Neurosurg 2015; 87:381-91. [PMID: 26724618 DOI: 10.1016/j.wneu.2015.12.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Traumatic odontoid fractures (tOFs) in the very elderly are associated with high morbidity and mortality. The best treatment strategy (conservative vs. surgery) is still unclear. METHODS Between April 2008 and April 2014, fifty (17 male, 33 female) patients (mean age 87.2 ± 4.4 years; range: 80-99) were included in this retrospective cohort study. All patients underwent posterior fusion surgery for tOF. Early outcome, morbidity and mortality, length of hospital and intensive care unit (ICU) stay, comorbidities, and perioperative complications were assessed. RESULTS The mean age-adjusted Charlson Comorbidity Index (CCI) was 5.8 ± 3.9 (range: 0-13), and the mean American Society of Anesthesiologists score was 3 ± 0.5 (range: 2-4). Surgery was delayed in 48% of patients. Thirty percent of patients had preoperative complications (72.4% severe), of which a leading cause was dysphagia with subsequent pneumonia, and 18% required preoperative assessment or improvement of health status. Surgery-related complications were experienced in 14% with no neurovascular lesion. Postoperative medical complications occurred in 52% of patients (67.3% severe). Major complications were mostly respiratory/pulmonary (66.7%), of which postoperative pneumonia (36.4%) was leading. Twenty-four percent of patients were ICU monitored. Mean length of ICU stay was 9 ± 6.6 days (1-20). Mean length of hospital stay was 15 ± 8.6 days (4-56). There was no in-hospital mortality, and 30-day mortality was 6%. CONCLUSIONS Posterior fusion for tOF in patients 80 years or older seems to be a feasible treatment option in these high-risk patients. Despite a high incidence of severe comorbidities and perioperative complications, outcome was satisfactory. LEVEL OF EVIDENCE Our research was a retrospective cohort study, Level III.
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Affiliation(s)
- Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Elisabeth Török
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Insa Janssen
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas Reinke
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Niels Buchmann
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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9
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Yang Z, Yuan ZZ, Ma JX, Ma XL. Conservative versus surgical treatment for type II odontoid fractures in the elderly: Grading the evidence through a meta-analysis. Orthop Traumatol Surg Res 2015; 101:839-44. [PMID: 26494619 DOI: 10.1016/j.otsr.2015.08.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 08/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Odontoid fractures are common C-spine fractures in the elderly. However, the optimal treatment of odontoid fractures in the elderly is, still subject to controversy. HYPOTHESIS Surgical treatment has several advantages on conservative treatment, such as reduced mortality and lower incidence of non-union. This meta-analysis was performed to identify the efficacy of conservative treatment compared with surgical treatment and provides recommendations for using these procedures to treat type II odontoid fractures in the elderly. MATERIALS AND METHODS A systematic search of all studies published was conducted using the PubMed, EMBASE, OVID, ScienceDirect and Cochrane CENTRAL databases. The randomized controlled trials (RCTs) and non-randomized controlled trials (non-RCTs) that compared conservative treatment with surgical treatment and provided data on clinical effects were identified. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.1 was used for data analysis. RESULTS Twelve studies involving 730 patients met the inclusion criteria. There were 441 patients with conservative treatment and 289 with surgical treatment. The results of meta-analysis indicated that no difference with regard to the mortality was noted (P > 0.05) between the two procedures. However, there was statistically significant difference with respect to the non-union numbers (P < 0.05) between the two procedures. DISCUSSION Conservative treatment and surgical treatment are both effective procedures for treating type II odontoid fractures in the elderly. Compared with surgical treatment, there is no significant difference in mortality; With respect to non-union numbers, conservative treatment numbers are higher than surgical treatment. Due to the poor quality of the evidence currently available, high quality RCTs are required. Level of evidence Level II: low-powered prospective randomized trial meta-analysis.
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Affiliation(s)
- Z Yang
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin 300211, China
| | - Z-Z Yuan
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin 300211, China
| | - J-X Ma
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin 300211, China
| | - X-L Ma
- Department of Orthopaedics, Tianjin Hospital, 406 Jiefang Nan Street, Hexi District, Tianjin 300211, China.
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10
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Terreaux L, Loubersac T, Hamel O, Bord E, Robert R, Buffenoir K. Odontoid balloon kyphoplasty associated with screw fixation for Type II fracture in 2 elderly patients. J Neurosurg Spine 2015; 22:246-52. [PMID: 25555053 DOI: 10.3171/2014.11.spine131013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Anterior screw fixation is a well-recognized technique that is used to stabilize Type IIB fractures of the odontoid process in the elderly. However, advanced age and osteoporosis are 2 risk factors for pseudarthrosis. Kyphoplasty has been described in the treatment of lytic lesions in C-2. The authors decided to combine these 2 techniques in the treatment of unstable fractures of the odontoid. Two approximately 90-year-old patients were treated for this type of fracture. Instability was demonstrated on dynamic radiography in one patient, and the fracture was seen on static radiography in the other. Clinical parameters, pain, range of motion, 36-Item Short Form Health Survey (SF-36) score (for the first patient), and radiological examinations (CT scans and dynamic radiographs) were studied both before and after surgery. After inflating the balloon both above and below the fracture line, the authors applied a high-viscosity polymethylmethacrylate cement. Some minor leakage of cement was noted in both cases but proved to be harmless. The screws were correctly positioned. The clinical result was excellent, both in terms of pain relief and in the fact that there was no reduction in the SF-36 score. The range of motion remained the same. A follow-up CT scan obtained 1 year later in one of the patients showed no evidence of change in the materials used, and the dynamic radiographs showed no instability. This combination of kyphoplasty and anterior screw fixation of the odontoid seems to be an interesting technique in osteoporotic Type IIB fractures of the odontoid process in the elderly, with good results both clinically and radiologically.
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Affiliation(s)
- Luc Terreaux
- Department of Neurosurgery and Neurotraumatology, Nantes University Hospital; and
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Systematic review on surgical and nonsurgical treatment of type II odontoid fractures in the elderly. BIOMED RESEARCH INTERNATIONAL 2014; 2014:231948. [PMID: 24683543 PMCID: PMC3934525 DOI: 10.1155/2014/231948] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 12/28/2013] [Indexed: 11/18/2022]
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.
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