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 Dynamic cervical spine x
39 Electronic Supplementary Material
40 Graphical AbstractThese slides
41 II odontoid fractures
42 Neck Disability Index
43 PurposeAnalysis
44 Rankin Scale
45 SWPS
46 SWPS values
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 effect
69 effects of age
70 elderly patients
71 evaluation
72 favorable functional outcome
73 female sex
74 fracture dislocation
75 fracture gap
76 fractures
77 function
78 functional evaluation
79 functional outcome
80 fusion
81 gap
82 geriatric patients
83 geriatric type II odontoid fractures
84 goal
85 group
86 hard collar immobilization
87 higher values
88 immobilization
89 index
90 levels
91 logistic regression analysis
92 mRS-post
93 mRS-pre
94 materials
95 months
96 neurological deficits
97 odontoid angulation
98 odontoid fractures
99 osseous fusion
100 outcomes
101 pain scale
102 patients
103 post-treatment levels
104 pre-injury clinical status
105 radiological outcomes
106 rays
107 regression analysis
108 relation
109 scale
110 scores
111 sex
112 slides
113 spine CT
114 spine X
115 stable union
116 status
117 supplementary material
118 surgery
119 total
120 treatment
121 type II odontoid fractures
122 values
123 worse NDI
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