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European Spine Journal
Published in: European Spine Journal 1/2013

01-01-2013 | Review Article

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

Authors: Jeroen G. J. Huybregts, Wilco C. H. Jacobs, Carmen L. A. M. Vleggeert-Lankamp

Published in: European Spine Journal | Issue 1/2013

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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 (≥65 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.
Literature
1.
Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56(8):1663–1674PubMed
2.
Andersson S, Rodrigues M, Olerud C (2000) Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. Eur Spine J 9(1):56–59PubMedCrossRef
3.
Berlemann U, Schwarzenbach O (1997) Dens fractures in the elderly: results of anterior screw fixation in 19 elderly patients. Acta Orthop Scand 68(4):319–324PubMedCrossRef
4.
Borm W, Kast E, Richter HP, Mohr K (2003) Anterior screw fixation in type II odontoid fractures: is there a difference in outcome between age groups? Neurosurgery 52(5):1089–1092PubMedCrossRef
5.
Butler JS, Dolan RT, Burbridge M et al (2010) The long-term functional outcome of type II odontoid fractures managed non-operatively. Eur Spine J 19(10):1635–1642PubMedCrossRef
6.
Carreon LY, Glassman SD, Campbell MJ, Anderson PA (2010) Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 10(6):469–474PubMedCrossRef
7.
Chan K, Bhandari M (2011) Three-minute critical appraisal of a case series article. Indian J Orthop 45(2):103–104PubMedCrossRef
8.
Cleland JA, Fritz JM, Whitman JM, Palmer JA (2006) The reliability and construct validity of the Neck Disability Index and patient specific functional scale in patients with cervical radiculopathy. Spine (Phila Pa 1976) 31(5):598–602CrossRef
9.
10.
11.
12.
Cowley DE (1995) Prostheses for primary total hip replacement: a critical appraisal of the literature. Int J Technol Assess Health Care 11(4):770–778PubMedCrossRef
13.
Dailey AT, Hart D, Finn MA, Schmidt MH, Apfelbaum RI (2010) Anterior fixation of odontoid fractures in an elderly population. J Neurosurg Spine 12(1):1–8PubMedCrossRef
14.
Grauer JN, Shafi B, Hilibrand AS et al (2005) Proposal of a modified, treatment-oriented classification of odontoid fractures. Spine J 5(2):123–129PubMedCrossRef
15.
Hanigan WC, Powell FC, Elwood PW, Henderson JP (1993) Odontoid fractures in the elderly patient. Clin Res 41(3):A710
16.
17.
Harrop JS, Hart R, Anderson PA (2010) Optimal treatment for odontoid fractures in the elderly. Spine 35(21):S219–S227PubMedCrossRef
18.
Henaux PL, Cueff F, Diabira S et al (2011) Anterior screw fixation of type IIB odontoid fractures in octogenarians. Eur Spine J 21(2):335–339PubMedCrossRef
19.
Hou Y, Yuan W, Wang X (2011) Clinical evaluation of anterior screw fixation for elderly patients with type II odontoid fractures. J Spinal Disord Tech 24(8):75–81
20.
Hsu WK, Anderson PA (2010) Odontoid fractures: update on management. J Am Acad Orthopaedic Surg 18(7):383–394
21.
Kaminski A, Gstrein A, Muhr G, Muller EJ (2008) Transarticular C1–C2 screw fixation: results of unstable odontoid fractures and pseudarthrosis in the elderly. Unfallchirurg 111(3):167–172PubMedCrossRef
22.
Koech F, Ackland HM, Varma DK, Williamson OD, Malham GM (2008) Nonoperative management of type II odontoid fractures in the elderly. Spine 33(26):2881–2886PubMedCrossRef
23.
Koivikko MP, Kiuru MJ, Koskinen SK, Myllynen P, Santavirta S, Kivisaari L (2004) Factors associated with nonunion in conservatively treated type-II fractures of the odontoid process. J Bone Joint Surg Br 86(8):1146–1151PubMedCrossRef
24.
Kuntz C, Mirza SK, Jarell AD, Chapman JR, Shaffrey CI, Newell DW (2000) Type II odontoid fractures in the elderly: early failure of nonsurgical treatment. Neurosurg Focus 8(6):e7PubMedCrossRef
25.
Lefranc M, Peltier J, Fichten A, Desenclos C, Toussaint P, Le GD (2009) Odontoid process fracture in elderly patients over 70 years: morbidity, handicap, and role of surgical treatment in a retrospective series of 27 cases. Neurochirurgie 55(6):543–550PubMedCrossRef
26.
Molinari RW, Dahl J, Gruhn WL, Molinari WJ (2011) Functional outcomes, morbidity, mortality, and fracture healing in 26 consecutive geriatric odontoid fracture patients treated with posterior fusion. J Spinal Disord Tech 197(5):1229–1234
27.
Molinari RW, Khera OA, Gruhn WL, McAssey RW (2011) Rigid cervical collar treatment for geriatric type II odontoid fractures. Eur Spine J 21(5):855–862PubMedCrossRef
28.
Muller EJ, Wick M, Russe O, Muhr G (1999) Management of odontoid fractures in the elderly. Eur Spine J 8(5):360–365PubMedCrossRef
29.
Osti M, Philipp H, Meusburger B, Benedetto KP (2011) Analysis of failure following anterior screw fixation of Type II odontoid fractures in geriatric patients. Eur Spine J 20(11):1915–1920PubMedCrossRef
30.
Platzer P, Thalhammer G, Oberleitner G, Schuster R, Vecsei V, Gaebler C (2007) Surgical treatment of dens fractures in elderly patients. J Bone Joint Surg Am 89(8):1716–1722PubMedCrossRef
31.
Platzer P, Thalhammer G, Ostermann R, Wieland T, Vecsei V, Gaebler C (2007) Anterior screw fixation of odontoid fractures comparing younger and elderly patients. Spine (Phila Pa 1976) 32(16):1714–1720CrossRef
32.
Reinhold M, Bellabarba C, Bransford R et al (2011) Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity. Eur Spine J 20(11):1928–1939
33.
Seybold EA, Bayley JC (1998) Functional outcome of surgically and conservatively managed dens fractures. Spine (Phila Pa 1976) 23(17):1837–1845CrossRef
34.
Shears E, Armitstead CP (2008) Surgical versus conservative management for odontoid fractures. Cochrane Database Syst Rev 4:CD005078PubMed
35.
Tashjian RZ, Majercik S, Biffl WL, Palumbo MA, Cioffi WG (2006) Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures. J Trauma 60(1):199–203PubMedCrossRef
36.
37.
White AP, Hashimoto R, Norvell DC, Vaccaro AR (2010) Morbidity and mortality related to odontoid fracture surgery in the elderly population. Spine 35(9):S146–S157PubMedCrossRef
38.
Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD (2009) Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J 9(10):802–808PubMedCrossRef
39.
Young IA, Cleland JA, Michener LA, Brown C (2010) Reliability, construct validity, and responsiveness of the neck disability index, patient-specific functional scale, and numeric pain rating scale in patients with cervical radiculopathy. Am J Phys Med Rehabil 89(10):831–839PubMedCrossRef
Metadata
Title
The optimal treatment of type II and III odontoid fractures in the elderly: a systematic review
Authors
Jeroen G. J. Huybregts
Wilco C. H. Jacobs
Carmen L. A. M. Vleggeert-Lankamp
Publication date
01-01-2013
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 1/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-012-2452-3

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