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

Author

Huybregts, Jeroen G J, Polak, Samuel B, Jacobs, Wilco C, Arts, Mark P, Meyer, Bernhard, Wostrack, Maria, Butenschön, Vicki M, Osti, Michael, Öner, F Cumhur, Slooff, Willem-Bart M, Feller, Ricardo E, Bouma, Gert-Joan, Harhangi, Biswadjiet S, Depreitere, Bart, Nygaard, Øystein P, Weber, Clemens, Müller, Kay, Timothy, Jake, Pellisé, Ferran, and Rasmussen, Mikkel M

Subjects
*CERVICAL vertebrae injuries, *NECK pain treatment, *CONSERVATIVE treatment, *PAIN measurement, *SURGERY, *PATIENTS, *T-test (Statistics), *CERVICAL collars, *RESEARCH funding, *COMPUTED tomography, *QUESTIONNAIRES, *LOGISTIC regression analysis, *ORTHOPEDIC implants, *DISABILITY evaluation, *VERTEBRAL fractures, *TREATMENT effectiveness, *DECISION making, *DESCRIPTIVE statistics, *CHI-squared test, *LONGITUDINAL method, *SPINAL fusion, *CERVICAL vertebrae, *COMPARATIVE studies, *DATA analysis software, *CONFIDENCE intervals, *REGRESSION analysis, *OLD age
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. [ABSTRACT FROM AUTHOR]

Published
2024
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3. Low-Threshold-For-Surgery Versus Primarily-Conservative Treatment for Odontoid Fractures in the Elderly: Evaluating Practice Variation in The Netherlands

Author

Huybregts, Jeroen G. J., primary, Polak, Samuel B., additional, Jacobs, Wilco C. H., additional, Krekels-Huijbregts, Ilse A., additional, Smeets, Anouk Y. J. M., additional, Arts, Mark P., additional, Slooff, Willem-Bart M., additional, Öner, F. Cumhur, additional, Peul, Wilco C., additional, van Santbrink, Henk, additional, and Vleggeert-Lankamp, Carmen L. A., additional

Published
2023
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6. Low-Threshold-For-Surgery Versus Primarily-Conservative Treatment for Odontoid Fractures in the Elderly: Evaluating Practice Variation in The Netherlands

Author

Huybregts, Jeroen G. J., Polak, Samuel B., Jacobs, Wilco C. H., Krekels-Huijbregts, Ilse A., Smeets, Anouk Y. J. M., Arts, Mark P., Slooff, Willem-Bart M., Öner, F. Cumhur, Peul, Wilco C., van Santbrink, Henk, and Vleggeert-Lankamp, Carmen L. A.

Abstract

Study Design Retrospective cohort study.Objectives Odontoid fractures are the most common cervical spine fractures in the elderly. The optimal treatment remains controversial. The aim of this study was to compare results of a low-threshold-for-surgery strategy (surgery for dislocated fractures in relatively healthy patients) to a primarily-conservative strategy (for all patients).Methods Patient records from 5 medical centers were reviewed for patients who met the selection criteria (e.g. age ≥55 years, type II/III odontoid fractures). Demographics, fracture types/characteristics, fracture union/stability, clinical outcome and mortality were compared. The influence of age on outcome was studied (≥55-80 vs ≥80 years).Results A total of 173 patients were included: 120 treated with low-threshold-for-surgery (of which 22 primarily operated, and 23 secondarily) vs 53 treated primarily-conservative. No differences in demographics and fracture characteristics between the groups were identified. Fracture union (53% vs 43%) and fracture stability (90% vs 85%) at last follow-up did not differ between groups. The majority of patients (56%) achieved clinical improvement compared to baseline. Analysis of differences in clinical outcome between groups was infeasible due to data limitations. In both strategies, patients ≥80 years achieved worse union (64% vs 30%), worse stability (97% vs 77%), and – as to be expected – increased mortality <104 weeks (2% vs 22%).Conclusions Union and stability rates did not differ between the treatment strategies. Advanced age (≥80 years) negatively influenced both radiological outcome and mortality. No cases of secondary neurological deficits were identified, suggesting that concerns for the consequences of under-treatment may be unjustified.

Published
2024
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8. Rationale and design of the INNOVATE Trial: an international cooperative study on surgical versus conservative treatment for odontoid fractures in the elderly.

Author

Huybregts, Jeroen G. J., Jacobs, Wilco C. H., Peul, Wilco C., and Vleggeert-Lankamp, Carmen L. A.

Subjects
*TREATMENT of fractures, *RHEUMATOID arthritis, *COMPUTED tomography, *OSTEOPOROSIS, *CERVICAL vertebrae
Abstract

Background Fractures of the odontoid process of the axis are the most common fractures of the geriatric cervical spine. As the population ages, their incidence is expected to increase progressively, as is the number of very old patients (>80 years) with an odontoid fracture. No consensus exists on the optimal treatment (surgical or conservative) and the most relevant outcome parameter (osseous union, fracture stability or clinical outcome). The aim of the INNOVATE (INterNational study on Odontoid frActure Treatment in the Elderly) Trial is to prospectively assess fracture healing and clinical outcome after surgical and conservative treatment for odontoid fractures in the elderly patient, with a specific focus on the very old patient. Methods/Design The trial is an observational study in which eleven centres in five European countries are involved. All patients admitted to one of these centres who meet the selection criteria (≥55 years, acute (

Published
2014
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