Abstract
Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Methods: A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI). From 12–15 months after treatment, functional evaluations were performed employing a second modified Rankin Scale (mRS-post) together with Neck Disability Index (NDI) and Smiley-Webster pain scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine X-rays at 3 months and cervical spine CT scans 6 months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap > 2 mm, an antero-posterior displacement > 5 mm, an odontoid angulation > 11° or neurological deficits occurred. Results: Among the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p = 0.60), CCI (p = 0.85) and mRS-pre (p = 0.14) were noted. Similarly, no differences in mRS-post (p = 0.96), SWPS (p = 0.85) and NDI (p = 0.51) were observed between patients who reached an osseous fusion and those with a stable fibrous non-union. No effects of age, sex, ASA, mRS-pre, fracture dislocation and radiological outcome were discovered on functional outcome. At logistic regression analysis, female sex and high values of CCI emerged associated with worse NDI. Conclusions: In geriatric type II odontoid fractures, pre-injury clinical status and comorbidities overcome imaging in determining post-treatment level of function. Hard collar immobilization led to a favourable functional outcome with mRS-post, NDI and SWPS values diffusely encouraging whatever a bony union or a fibrous non-union was obtained. Graphical Abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
| Original language | English |
|---|---|
| Journal | European Spine Journal |
| DOIs | |
| Publication status | Accepted/In press - Jan 1 2019 |
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Keywords
- Collar
- Elderly
- Fracture
- Healing
- Odontoid
- Outcome
ASJC Scopus subject areas
- Surgery
- Orthopedics and Sports Medicine
Cite this
Type II odontoid fracture in elderly patients treated conservatively : is fracture healing the goal? / Lofrese, Giorgio; Musio, Antonio; De Iure, Federico; Cultrera, Francesco; Martucci, Antonio; Iaccarino, Corrado; Essayed, Walid Ibn; Ghadirpour, Reza; Servadei, Franco; Cavallo, Michele Alessandro; De Bonis, Pasquale.
In: European Spine Journal, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Type II odontoid fracture in elderly patients treated conservatively
T2 - is fracture healing the goal?
AU - Lofrese, Giorgio
AU - Musio, Antonio
AU - De Iure, Federico
AU - Cultrera, Francesco
AU - Martucci, Antonio
AU - Iaccarino, Corrado
AU - Essayed, Walid Ibn
AU - Ghadirpour, Reza
AU - Servadei, Franco
AU - Cavallo, Michele Alessandro
AU - De Bonis, Pasquale
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Methods: A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI). From 12–15 months after treatment, functional evaluations were performed employing a second modified Rankin Scale (mRS-post) together with Neck Disability Index (NDI) and Smiley-Webster pain scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine X-rays at 3 months and cervical spine CT scans 6 months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap > 2 mm, an antero-posterior displacement > 5 mm, an odontoid angulation > 11° or neurological deficits occurred. Results: Among the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p = 0.60), CCI (p = 0.85) and mRS-pre (p = 0.14) were noted. Similarly, no differences in mRS-post (p = 0.96), SWPS (p = 0.85) and NDI (p = 0.51) were observed between patients who reached an osseous fusion and those with a stable fibrous non-union. No effects of age, sex, ASA, mRS-pre, fracture dislocation and radiological outcome were discovered on functional outcome. At logistic regression analysis, female sex and high values of CCI emerged associated with worse NDI. Conclusions: In geriatric type II odontoid fractures, pre-injury clinical status and comorbidities overcome imaging in determining post-treatment level of function. Hard collar immobilization led to a favourable functional outcome with mRS-post, NDI and SWPS values diffusely encouraging whatever a bony union or a fibrous non-union was obtained. Graphical Abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
AB - Purpose: Analysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome. Methods: A total of 50 geriatric patients with type II odontoid fractures were treated with Aspen/Vista collars. On admission, each patient was assessed assigning ASA score, modified Rankin Scale (mRS-pre) and Charlson Comorbidity Index (CCI). From 12–15 months after treatment, functional evaluations were performed employing a second modified Rankin Scale (mRS-post) together with Neck Disability Index (NDI) and Smiley-Webster pain scale (SWPS). Radiological outcome was evaluated through dynamic cervical spine X-rays at 3 months and cervical spine CT scans 6 months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap > 2 mm, an antero-posterior displacement > 5 mm, an odontoid angulation > 11° or neurological deficits occurred. Results: Among the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p = 0.60), CCI (p = 0.85) and mRS-pre (p = 0.14) were noted. Similarly, no differences in mRS-post (p = 0.96), SWPS (p = 0.85) and NDI (p = 0.51) were observed between patients who reached an osseous fusion and those with a stable fibrous non-union. No effects of age, sex, ASA, mRS-pre, fracture dislocation and radiological outcome were discovered on functional outcome. At logistic regression analysis, female sex and high values of CCI emerged associated with worse NDI. Conclusions: In geriatric type II odontoid fractures, pre-injury clinical status and comorbidities overcome imaging in determining post-treatment level of function. Hard collar immobilization led to a favourable functional outcome with mRS-post, NDI and SWPS values diffusely encouraging whatever a bony union or a fibrous non-union was obtained. Graphical Abstract: These slides can be retrieved under Electronic Supplementary Material.[Figure not available: see fulltext.].
KW - Collar
KW - Elderly
KW - Fracture
KW - Healing
KW - Odontoid
KW - Outcome
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UR - http://www.scopus.com/inward/citedby.url?scp=85060602603&partnerID=8YFLogxK
U2 - 10.1007/s00586-019-05898-2
DO - 10.1007/s00586-019-05898-2
M3 - Article
AN - SCOPUS:85060602603
JO - European Spine Journal
JF - European Spine Journal
SN - 0940-6719
ER -