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

Jeroen G.J. Huybregts; Samuel B. Polak; Wilco C. Jacobs; Mark P. Arts; Bernhard Meyer; Maria Wostrack; Vicki M. Butenschön; Michael Osti; F. Cumhur Öner; Willem Bart M. Slooff; Ricardo E. Feller; Gert Joan Bouma; Biswadjiet S. Harhangi; Bart Depreitere; Øystein P. Nygaard; Clemens Weber; Kay Müller; Jake Timothy; Ferran Pellisé; Mikkel M. Rasmussen; Erik W. van Zwet; Ewout W. Steyerberg; Wilco C. Peul; Carmen L.A. Vleggeert-Lankamp

doi:10.1093/ageing/afae189

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

Jeroen G.J. Huybregts^*, Samuel B. Polak, Wilco C. Jacobs, Mark P. Arts, Bernhard Meyer, Maria Wostrack, Vicki M. Butenschön, Michael Osti, F. Cumhur Öner, Willem Bart M. Slooff, Ricardo E. Feller, Gert Joan Bouma, Biswadjiet S. Harhangi, Bart Depreitere, Øystein P. Nygaard, Clemens Weber, Kay Müller, Jake Timothy, Ferran Pellisé, Mikkel M. RasmussenErik W. van Zwet, Ewout W. Steyerberg, Wilco C. Peul, Carmen L.A. Vleggeert-Lankamp

^*Corresponding author for this work

Neurosurgery

Research output: Contribution to journal › Article › Academic › peer-review

1 Citation (Scopus)

2 Downloads (Pure)

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.

Original language	English
Article number	afae189
Journal	Age and Ageing
Volume	53
Issue number	8
DOIs	https://doi.org/10.1093/ageing/afae189
Publication status	Published - Aug 2024

Bibliographical note

Publisher Copyright:
© The Author(s) 2024.

Access to Document

10.1093/ageing/afae189Licence: CC BY-NC-ND

Surgical versus conservative treatment for odontoid fractures in older peopleFinal published version, 639 KBLicence: CC BY-NC-ND

Cite this

Huybregts, J. G. J., Polak, S. B., Jacobs, W. C., Arts, M. P., Meyer, B., Wostrack, M., Butenschön, V. M., Osti, M., Öner, F. C., Slooff, W. B. M., Feller, R. E., Bouma, G. J., Harhangi, B. S., Depreitere, B., Nygaard, Ø. P., Weber, C., Müller, K., Timothy, J., Pellisé, F., ... Vleggeert-Lankamp, C. L. A. (2024). Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study. Age and Ageing, 53(8), Article afae189. https://doi.org/10.1093/ageing/afae189

@article{01609a1526e94c1a8c6d3deff9a91307,

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

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.",

author = "Huybregts, {Jeroen G.J.} and Polak, {Samuel B.} and Jacobs, {Wilco C.} and Arts, {Mark P.} and Bernhard Meyer and Maria Wostrack and Butensch{\"o}n, {Vicki M.} and Michael Osti and {\"O}ner, {F. Cumhur} and Slooff, {Willem Bart M.} and Feller, {Ricardo E.} and Bouma, {Gert Joan} and Harhangi, {Biswadjiet S.} and Bart Depreitere and Nygaard, {{\O}ystein P.} and Clemens Weber and Kay M{\"u}ller and Jake Timothy and Ferran Pellis{\'e} and Rasmussen, {Mikkel M.} and {van Zwet}, {Erik W.} and Steyerberg, {Ewout W.} and Peul, {Wilco C.} and Vleggeert-Lankamp, {Carmen L.A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = aug,

doi = "10.1093/ageing/afae189",

language = "English",

volume = "53",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "8",

}

Huybregts, JGJ, Polak, SB, Jacobs, WC, Arts, MP, Meyer, B, Wostrack, M, Butenschön, VM, Osti, M, Öner, FC, Slooff, WBM, Feller, RE, Bouma, GJ, Harhangi, BS, Depreitere, B, Nygaard, ØP, Weber, C, Müller, K, Timothy, J, Pellisé, F, Rasmussen, MM, van Zwet, EW, Steyerberg, EW, Peul, WC & Vleggeert-Lankamp, CLA 2024, 'Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study', Age and Ageing, vol. 53, no. 8, afae189. https://doi.org/10.1093/ageing/afae189

TY - JOUR

T1 - Surgical versus conservative treatment for odontoid fractures in older people

T2 - an international prospective comparative study

AU - Huybregts, Jeroen G.J.

AU - Polak, Samuel B.

AU - Jacobs, Wilco C.

AU - Arts, Mark P.

AU - Meyer, Bernhard

AU - Wostrack, Maria

AU - Butenschön, Vicki M.

AU - Osti, Michael

AU - Öner, F. Cumhur

AU - Slooff, Willem Bart M.

AU - Feller, Ricardo E.

AU - Bouma, Gert Joan

AU - Harhangi, Biswadjiet S.

AU - Depreitere, Bart

AU - Nygaard, Øystein P.

AU - Weber, Clemens

AU - Müller, Kay

AU - Timothy, Jake

AU - Pellisé, Ferran

AU - Rasmussen, Mikkel M.

AU - van Zwet, Erik W.

AU - Steyerberg, Ewout W.

AU - Peul, Wilco C.

AU - Vleggeert-Lankamp, Carmen L.A.

PY - 2024/8

Y1 - 2024/8

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85202747563&partnerID=8YFLogxK

U2 - 10.1093/ageing/afae189

DO - 10.1093/ageing/afae189

M3 - Article

C2 - 39193720

AN - SCOPUS:85202747563

SN - 0002-0729

VL - 53

JO - Age and Ageing

JF - Age and Ageing

IS - 8

M1 - afae189

ER -

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

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this