Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases
The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment.
Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson–D’Alonzo and Roy–Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation.
Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment.
Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.
KeywordsOdontoid fracture Epidemiology Morbidity Mortality Fusion
The authors would like to thank the French Society of Spine Surgery (SFCR) for funding the online database (KEOPS) license and the methodological support provided by the Pôle IMER (Lyon, France).
The French Society of Spine Surgery (SFCR) funded the online database (KEOPS) license and the methodological support.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval (Reference FC 2018-28) was obtained for this observational study.
- 2.Chapman J, Smith SS, Kopjar B, Vaccaro AR, Arnold P, Shaffrey CI, Fehlings MG (2013) The AOSpine North America geriatric odontoid fracture mortality study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976) 38(13):1098–1104CrossRefGoogle Scholar
- 4.Clark S, Nash A, Shasti M, Brown L, Jauregui JJ, Mistretta K, Koh E, Banagan K, Ludwig S, Gelb D (2018) Mortality rates following posterior C1–2 fusion for displaced type II odontoid fractures in octogenarians. Spine (Phila Pa 1976) 43(18):E1077–E1081Google Scholar
- 9.Yuan S, Wei B, Tian Y, Yan J, Xu W, Wang L, Liu X (2018) The comparison of clinical outcome of fresh type II odontoid fracture treatment between anterior cannulated screws fixation and posterior instrumentation of C1-2 without fusion: a retrospective cohort study. J Orthop Surg Res 13(1):3. https://doi.org/10.1186/s13018-017-0702-0 CrossRefPubMedGoogle Scholar