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Odontoid Type II fractures in elderly: what are the real management goals and how to best achieve them? A multicenter European study on functional outcome

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Abstract

Odontoid fractures constitute the most common cervical fractures in elderly. External immobilization is the treatment of choice for Type I and III; there is still no wide consensus about the best management of Type II fractures. Observational multicenter study was conducted on a prospectively built database on elderly patients (> 75 years) with Type II odontoid fracture managed conservatively during the last 10 years. All patients underwent CT scan on admission and at 3 months; if indicated, selected patient had CT scan at 6 and 12 months. All patients were clinically evaluated by Neck Disability Index (NDI), Charlson Comorbidity Index (CCI), and American Society of Anaesthesiologists classification (ASA) on admission; NDI was assessed also at 6 weeks, 3, 6, 12, and 24 months; furthermore, a quality of life (QoL) assessment with the SF-12 form was performed at 3 and 12 months. Among the 260 patients enrolled, 177 (68%) were women and 83 (32%) men, with a median age of 83 years. Patients were followed up for a minimum of 24 months: 247 (95%) showed an excellent functional outcome within 6 weeks, among them 117 (45%) showed a good bony healing, whereas 130 (50%) healed in pseudo-arthrosis. The residual 5% were still variably symptomatic at 12 weeks; however, only 5 out of 13 (2% of the total cohort) required delayed surgery. This study showed that a conservative approach to odontoid Type II fracture in elderly is an effective and valid option, resulting in an excellent functional outcome (regardless of bony fusion) in the majority of cases. Failure of conservative treatment can be safely addressed with surgical fixation at a later stage.

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Authors and Affiliations

  1. Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France

    Salvatore Chibbaro, Charles-Henry Mallereau, Maria Teresa Bozzi, Antonino Scibilia, Helene Cebula, Irene Ollivier, Marie-Pierre Loit, Dominique Chaussemy, Hugo-Andres Coca, Guillaume Dannhoff, François Proust & Julien Todeschi

  2. Department of Neurosurgery, Oxford University Hospital, Oxford, UK

    Mario Ganau

  3. Department of Neurosurgery, Humanitas University Hospital, Rozzano, Italy

    Ismail Zaed

  4. Department of Neurosurgery, Parma University Hospital, Parma, Italy

    Antonio Romano

  5. Department of Neurosurgery, Teramo Hospital, Teramo, Italy

    Beniamino Nannavecchia

  6. Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany

    Arthur Gubian

  7. Department of Neurosurgery, Poli-Ambulanza Hospital, Brescia, Italy

    Giorgio Spatola

  8. Department of Neurosurgery, Bari University Hospital, Bari, Italy

    Francesco Signorelli

  9. Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy

    Corrado Iaccarino

  10. Division of Neurosurgery, University Hospital of Modena, Modena, Italy

    Corrado Iaccarino

  11. Neuroradiology Unit, Strasbourg University Hospital, Strasbourg, France

    Raoul Pop & Seyyid Baloglu

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  1. Salvatore Chibbaro
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Contributions

Salvatore Chibbaro, Charles-Henry Mallereau, Mario Ganau, Ismail Zaed, Maria Teresa Bozzi, Antonino Scibilia, Helene Cebula, Irene Ollivier, Marie-Pierre Loit, Dominique Chaussemy, Hugo-Andres Coca, Guillaume Dannhoff, Antonio Romano, Corrado Iaccarino, Beniamino Nannavecchia, Arthur Gubian, Giorgio Spatola, Francesco Signorelli, Raoul Pop, François Proust, Seyyid Baloglu, and Julien Todeschi contributed to the study conception, design, data analysis, writing, and reviewing. All authors read and approved the final manuscript.

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Correspondence to Charles-Henry Mallereau.

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This study was conducted according to the Ethical Principles for Medical Research Involving Human subjects stated in the 2004 and its further revision made in 2008 and 2013 of the Declaration of Helsinki. The study was approved by the IRB of the French National Neurosurgery society (Reference no: IRB00011687).

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Chibbaro, S., Mallereau, CH., Ganau, M. et al. Odontoid Type II fractures in elderly: what are the real management goals and how to best achieve them? A multicenter European study on functional outcome. Neurosurg Rev 45, 709–718 (2022). https://doi.org/10.1007/s10143-021-01594-2

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