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Functional Outcome After Odontoid Fractures in the Elderly

  • Pasquale De Bonis
  • Giorgio Trapella
  • Lorenzo Mongardi
  • Simone Olei
  • Antonio Musio
  • Corrado Iaccarino
  • Giorgio Lofrese
  • Filippo Molinari
  • Demo Dugoni
  • Reza Ghadirpour
  • Franco Servadei
  • Michele Alessandro Cavallo
Chapter
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)

Abstract

While several papers on mortality and the fusion rate in elderly patients treated surgically or non-surgically for odontoid fractures exist, little information is available on quality of life after treatment. The aim of treatment in these patients should not be fracture healing alone but also quality of life improvement.

A literature search using PubMed identified seven papers including information on functional evaluation of 402 patients.

Patients treated with anterior screw fixation had a good functional outcome in 92.6% of cases. This percentage seemed to decrease in octogenarians. Less information was available for patients treated with posterior approaches; it would seem that up to a half of such patients experienced pain and limitations in activities of daily living after surgery. Patients treated with a halo device had a functional outcome that was worse (or at least no better) than that of patients treated with surgery, with absence of limitations in activities of daily living in 77.3% of patients. Patients treated with a collar had a good functional outcome in the majority of cases, with absence of limitations in activities of daily living in 89% of patients.

More studies are needed for evaluation of functional outcome, especially in patients treated with a collar, a halo device or a posterior approach.

Keywords

Odontoid fracture Elderly patients Outcome evaluation Functional outcome Treatment Surgery Collar Halo 

Notes

Competing Interests

The authors declare that they have no competing interests.

Compliance with Ethical Standards

Yes financial support was received for this work.

References

  1. 1.
    Pal D, Sell P, Grevitt M. Type II odontoid fractures in the elderly: an evidence-based narrative review of management. Eur Spine J. 2011;20:195–204.CrossRefGoogle Scholar
  2. 2.
    Henaux PL, Cueff F, Diabira S, Riffaud L, Hamlat A, Brassier G, Morandi X. Anterior screw fixation of type IIB odontoid fractures in octogenarians. Eur Spine J. 2012;21:335–9.CrossRefGoogle Scholar
  3. 3.
    Hou Y, Yuan W, Wang X. Clinical evaluation of anterior screw fixation for elderly patients with type II odontoid fractures. J Spinal Disord Tech. 2011;24:E75–81.PubMedGoogle Scholar
  4. 4.
    Joestl J, Lang N, Bukaty A, Platzer P. A comparison of anterior screw fixation and halo immobilisation of type II odontoid fractures in elderly patients at increased risk from anaesthesia. Bone Joint J. 2016;98-B:1222–6.CrossRefGoogle Scholar
  5. 5.
    Joestl J, Lang NW, Tiefenboeck TM, Hajdu S, Platzer P. Management and outcome of dens fracture nonunions in geriatric patients. J Bone Joint Surg Am. 2016;98:193–8.CrossRefGoogle Scholar
  6. 6.
    Kohlhof H, Seidel U, Hoppe S, Keel MJ, Benneker LM. Cement-augmented anterior screw fixation of type II odontoid fractures in elderly patients with osteoporosis. Spine J. 2013;13:1858–63.CrossRefGoogle Scholar
  7. 7.
    Platzer P, Thalhammer G, Ostermann R, Wieland T, Vecsei V, Gaebler C. Anterior screw fixation of odontoid fractures comparing younger and elderly patients. Spine (Phila Pa 1976). 2007;32:1714–20.CrossRefGoogle Scholar
  8. 8.
    Schroeder GD, Kepler CK, Kurd MF, Paul JT, Rubenstein RN, Harrop JS, Brodke DS, Chapman JR, Vaccaro AR. A systematic review of the treatment of geriatric type II odontoid fractures. Neurosurgery. 2015;77(Suppl 4):S6–S14.CrossRefGoogle Scholar
  9. 9.
    Vaccaro AR, Kepler CK, Kopjar B, Chapman J, Shaffrey C, Arnold P, Gokaslan Z, Brodke D, France J, Dekutoski M, Sasso R, Yoon ST, Bono C, Harrop J, Fehlings MG. Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture. J Bone Joint Surg Am. 2013;95:729–35.CrossRefGoogle Scholar
  10. 10.
    Sasso RC. C2 dens fractures: treatment options. J Spinal Disord. 2001;14:455–63.CrossRefGoogle Scholar
  11. 11.
    Platzer P, Thalhammer G, Oberleitner G, Schuster R, Vecsei V, Gaebler C. Surgical treatment of dens fractures in elderly patients. J Bone Joint Surg Am. 2007;89:1716–22.CrossRefGoogle Scholar
  12. 12.
    Butler JS, Dolan RT, Burbridge M, Hurson CJ, O’Byrne JM, McCormack D, Synnott K, Poynton AR. The long-term functional outcome of type II odontoid fractures managed non-operatively. Eur Spine J. 2010;19:1635–42.CrossRefGoogle Scholar
  13. 13.
    Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14:409–15.PubMedGoogle Scholar
  14. 14.
    Guilfoyle MR, Seeley H, Laing RJ. The Short Form 36 Health Survey in spine disease—validation against condition-specific measures. Br J Neurosurg. 2009;23:401–5.CrossRefGoogle Scholar
  15. 15.
    BenDebba M, Heller J, Ducker TB, Eisinger JM. Cervical Spine Outcomes Questionnaire: its development and psychometric properties. Spine (Phila Pa 1976). 2002;27:2116–24.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Pasquale De Bonis
    • 1
    • 2
  • Giorgio Trapella
    • 1
    • 2
  • Lorenzo Mongardi
    • 1
  • Simone Olei
    • 1
  • Antonio Musio
    • 1
  • Corrado Iaccarino
    • 3
  • Giorgio Lofrese
    • 4
  • Filippo Molinari
    • 3
  • Demo Dugoni
    • 3
  • Reza Ghadirpour
    • 3
  • Franco Servadei
    • 3
  • Michele Alessandro Cavallo
    • 1
    • 2
  1. 1.NeurosurgerySant’Anna University HospitalFerraraItaly
  2. 2.Department of Morphology, Surgery and Experimental MedicineFerrara UniversityFerraraItaly
  3. 3.Neurosurgery–Neurotraumatology UnitUniversity Hospital of Parma—Emergency Neurosurgery, Institute of Scientific Research and Care, Arcispedale Santa Maria Nuova of Reggio EmiliaReggio EmiliaItaly
  4. 4.NeurosurgeryCesena HospitalCesenaItaly

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