Type II odontoid fracture in elderly patients treated conservatively: is fracture healing the goal? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2019-01-23

AUTHORS

Giorgio Lofrese, Antonio Musio, Federico De Iure, Francesco Cultrera, Antonio Martucci, Corrado Iaccarino, Walid Ibn Essayed, Reza Ghadirpour, Franco Servadei, Michele Alessandro Cavallo, Pasquale De Bonis

ABSTRACT

PurposeAnalysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome.MethodsA 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.ResultsAmong 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.ConclusionsIn 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 AbstractThese slides can be retrieved under Electronic Supplementary Material. More... »

PAGES

1064-1071

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00586-019-05898-2

DOI

http://dx.doi.org/10.1007/s00586-019-05898-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1111627903

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/30673876


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    "description": "PurposeAnalysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome.MethodsA 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\u201315\u00a0months 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\u00a0months and cervical spine CT scans 6\u00a0months after treatment. Three different conditions were identified: stable union, stable non-union and unstable non-union. Surgery was preferred whenever a fracture gap >\u20092\u00a0mm, an antero-posterior displacement >\u20095\u00a0mm, an odontoid angulation >\u200911\u00b0 or neurological deficits occurred.ResultsAmong the 50 patients, 24 reached a stable union, while 26 a stable non-union. Comparing the two groups, no differences in ASA (p\u2009=\u20090.60), CCI (p\u2009=\u20090.85) and mRS-pre (p\u2009=\u20090.14) were noted. Similarly, no differences in mRS-post (p\u2009=\u20090.96), SWPS (p\u2009=\u20090.85) and NDI (p\u2009=\u20090.51) 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.ConclusionsIn 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 AbstractThese slides can be retrieved under Electronic Supplementary Material.", 
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23 schema:description PurposeAnalysis of functional outcome of elderly patients with type II odontoid fractures treated conservatively in relation to their radiological outcome.MethodsA 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.ResultsAmong 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.ConclusionsIn 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 AbstractThese slides can be retrieved under Electronic Supplementary Material.
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30 schema:keywords ASA
31 ASA score
32 AbstractThese slides
33 Aspen/Vista collars
34 CT
35 Charlson Comorbidity Index
36 ConclusionsIn geriatric type II odontoid fractures
37 Disability Index
38 Electronic Supplementary Material
39 Graphical abstractThese slides
40 II odontoid fractures
41 Neck Disability Index
42 PurposeAnalysis
43 Rankin Scale
44 SWPS
45 SWPS values
46 Supplementary materials
47 Union
48 Vista collars
49 admission
50 age
51 analysis
52 angulation
53 antero-posterior displacement
54 bony union
55 cervical spine CT
56 cervical spine X
57 clinical status
58 collar
59 collar immobilization
60 comorbidities
61 comorbidity index
62 conditions
63 deficits
64 differences
65 different conditions
66 dislocations
67 displacement
68 dynamic cervical spine X
69 effect
70 effect of age
71 elderly patients
72 evaluation
73 favorable functional outcome
74 female sex
75 fracture dislocation
76 fracture gap
77 fractures
78 function
79 functional evaluation
80 functional outcome
81 fusion
82 gap
83 geriatric patients
84 geriatric type II odontoid fractures
85 goal
86 group
87 hard collar immobilization
88 higher values
89 immobilization
90 index
91 levels
92 logistic regression analysis
93 mRS-post
94 mRS-pre
95 materials
96 months
97 neurological deficits
98 odontoid angulation
99 odontoid fractures
100 osseous fusion
101 outcomes
102 pain scale
103 patients
104 post-treatment levels
105 pre-injury clinical status
106 radiological outcomes
107 rays
108 regression analysis
109 relation
110 scale
111 scores
112 sex
113 slides
114 spine CT
115 spine X
116 stable union
117 status
118 surgery
119 total
120 treatment
121 type II odontoid fractures
122 values
123 worse NDI
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