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Comparative Study
. 2024 Aug 6;53(8):afae189.
doi: 10.1093/ageing/afae189.

Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study

Jeroen G J Huybregts  1   2 , Samuel B Polak  1   2 , Wilco C Jacobs  3 , Mark P Arts  2 , Bernhard Meyer  4 , Maria Wostrack  4 , Vicki M Butenschön  4 , Michael Osti  5 , F Cumhur Öner  6 , Willem-Bart M Slooff  6 , Ricardo E Feller  7 , Gert-Joan Bouma  7 , Biswadjiet S Harhangi  8   9 , Bart Depreitere  10 , Øystein P Nygaard  11 , Clemens Weber  12   13 , Kay Müller  14 , Jake Timothy  15 , Ferran Pellisé  16 , Mikkel M Rasmussen  17 , Erik W van Zwet  18 , Ewout W Steyerberg  18 , Wilco C Peul  1   2 , Carmen L A Vleggeert-Lankamp  1   19
Affiliations
Comparative Study

Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study

Jeroen G J Huybregts et al. Age Ageing. .

Abstract

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.

Keywords: conservative treatment; odontoid fractures; older people; surgical treatment; treatment outcome.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Flow chart depicting the applied treatments and follow-up period for patients with odontoid fractures.
Figure 2
Figure 2
Line graphs displaying outcomes with 95% confidence intervals at various timepoints between treatments.
See this image and copyright information in PMC

References

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