Article
Comparison of clinical outcomes between two age groups after conservative and operative treatment of odontoid fractures
Vergleich der Altersgruppen bei 198 Patienten hinsichtlich der Stabilität nach konservativer und operativer Behandlung der Densfrakturen
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Authors
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Ahmed Elnewihi
- Uniklinik Magdeburg, Neurochirurgie, Magdeburg, Deutschland
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Michael Luchtmann
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
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Raimund Firsching
- Universitätsklinikum Magdeburg, Klinik für Neurochirurgie, Magdeburg, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Odontoid fractures (OF) represent about 20% of cervical fractures. They represent also the most common cervical fracture among patients older than 70 years and the most common vertebral fracture in patients older than 80 years. The study aimed to determine the stability outcome in either age group after conservative and operative treatments.
Methods: We reviewed data from 198 patients with OF between Feb. 2002 – Nov. 2016. We divided patients into two groups. Group I contained patients younger than 70 years (55 patients, 27.8%), group II patients older than 70 years (143 patients 72.2%). In our data (198 patients), 118 Patients (59.1%) were females, 81 patients were males (40.9%). Age ranged from 12 to 95 years (median of 78). The radiographs of 189 patients reveal type II fracture according to Anderson classification in 157 (83.1%) patients, 29 (15.3%) were classified as type III and 3 patients (1.6%) as type I. 35 patients (63.3%) were males, 20 patients (36.4%) were females. Age ranged from 12 to 69 years (median: 55). 48 patients (87.3%) were operatively treated, 7 patients (12.7%) were conservatively treated. In group II 97 patients (67.8&) were females, 46 patients (32.2%) were males. Age ranged from 70 to 95 years (median: 82). 114 patients (79.9%) were operatively treated and 29 patients (20.3%) were conservatively treated.
Results: Out of 53 patients in group I, 42 patients (79.2%) had a stable outcome. 11 patients (20.8%) showed instability, out of them 9 patients were operated (81.8%), 2 patients were treated conservatively (18.2%). The statistical analysis showed significant difference between the treatment option (operative vs. conservative) and the stability outcome (p= 0,009). In group II, out of 117 patients 92 had patients (78.6%) a stable outcome, 25 patients (21.4%) showed secondary instability, of these 24 patients (96%) were operatively treated, and 1 patient (4%) was treated onservatively. No relevant statistical difference was observed between the treatment options and outcome (p=1,00). The statistical analysis shows no difference between the 2 groups and the outcome (p= 0,696).
Conclusion: The treatment outcome of OF is not affected by patient age. Slightly higher rates of instability in the elderly patient collective did not reach statistical significance. No statistical significance between the age groups and the treatment method was found in the outcome data. The operative treatment with patients under 70 years had a higher fusion rate (p=0,009%).
