TY - JOUR
T1 - Surgical versus conservative treatment for odontoid fractures in older people
T2 - an international prospective comparative study
AU - Huybregts, Jeroen G.J.
AU - Polak, Samuel B.
AU - Jacobs, Wilco C.
AU - Arts, Mark P.
AU - Meyer, Bernhard
AU - Wostrack, Maria
AU - Butenschön, Vicki M.
AU - Osti, Michael
AU - Öner, F. Cumhur
AU - Slooff, Willem Bart M.
AU - Feller, Ricardo E.
AU - Bouma, Gert Joan
AU - Harhangi, Biswadjiet S.
AU - Depreitere, Bart
AU - Nygaard, Øystein P.
AU - Weber, Clemens
AU - Müller, Kay
AU - Timothy, Jake
AU - Pellisé, Ferran
AU - Rasmussen, Mikkel M.
AU - van Zwet, Erik W.
AU - Steyerberg, Ewout W.
AU - Peul, Wilco C.
AU - Vleggeert-Lankamp, Carmen L.A.
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Background: The optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population. Methods: An international prospective comparative study was conducted in fifteen European centres, involving patients aged ≥55 years with type II/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52 weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52 weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics. Results: The study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P = 0.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) −11 (2.4) vs. −14 (1.8), P = 0.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97–5.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) −13 (2.0) vs. −12 (2.8), P = 0.78). There was no difference for any of the secondary outcomes or subgroups. Conclusions: Clinical outcome and fracture healing at 52 weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.
AB - Background: The optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population. Methods: An international prospective comparative study was conducted in fifteen European centres, involving patients aged ≥55 years with type II/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52 weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52 weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics. Results: The study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P = 0.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) −11 (2.4) vs. −14 (1.8), P = 0.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97–5.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) −13 (2.0) vs. −12 (2.8), P = 0.78). There was no difference for any of the secondary outcomes or subgroups. Conclusions: Clinical outcome and fracture healing at 52 weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.
KW - conservative treatment
KW - odontoid fractures
KW - older people
KW - surgical treatment
KW - treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=85202747563&partnerID=8YFLogxK
U2 - 10.1093/ageing/afae189
DO - 10.1093/ageing/afae189
M3 - Article
C2 - 39193720
AN - SCOPUS:85202747563
SN - 0002-0729
VL - 53
JO - Age and Ageing
JF - Age and Ageing
IS - 8
M1 - afae189
ER -