gms | German Medical Science

Objective: Odontoid fractures comprise the most common cervical spine injuries in elderly patients. Failure after conservative or surgical management is common. We chose a clinically oriented definition of treatment-failure (TF) and aimed to identify factors that are related to TF.

Method: Retrospective analysis of patients admitted with traumatic odontoid fracture between 2003 and 2015. Inclusion criteria were age ≥60 years, interval between trauma and admission ≤6 weeks, complete clinical and radiological follow-up data ≥6 months post trauma, or death due to complications. Comorbidities were quantified using the Carlson Comorbidity Index (CCI; score increases with disease severity). Clinical outcome was measured with the 4-point Smiley-Webster (SW) Scale (favourable outcome = SW 1 or 2), and osseous union was assessed by CT (84%) or X-ray (16%). TF was defined as either 1. death during hospital course, 2. severe treatment-related complication, 3. (re-)operation due to osseous non-union, or 4. SW 3 or 4 in combination with osseous non-union.

Results: We identified 37 patients (f: n=20) with a median age of 78 years. The median time from trauma to hospital admission was one day and the median follow-up was 11 months. 81% of the study population had at least one comorbidity. 27 patients harboured a type II fracture and 10 a type III fracture. Surgical treatment was initiated in 19 and non-surgical treatment in 18 patients. Treatment-related complications occurred in 3 patients. Severe medical complications occurred in 7 patients and were leading to death in 6 patients. In 35% of the patients with follow-up ≥6 months an osseous non-union was documented. However, a favourable clinical outcome was found in 74% of patients (including 54% of patients with non-union). Outcome was classified as TF in 41% of patients. TF was found more often in older patients (p=0.042), in patients with a higher CCI (p=0.007) and with a lower leukocyte count on admission (p=0.04). Fracture type (p=0.258) or treatment modality (p=0.420) did not influence TF in our series.

Conclusions: The probability of a treatment failure after surgical and non-surgical management of odontoid fractures in the elderly population increases with age, presence of comorbidities and absence of a po-tentially beneficial systemic inflammatory response. Further studies are needed to investigate the impact of fracture type and treatment modality, and to clarify the role of inflammation for fracture healing.