Functional outcomes, morbidity, mortality and fracture healing rates in 58 consecutive geriatric odontoid fracture patients treated with cervical collar or posterior fusion

Abstract

BACKGROUND CONTEXT: There is much debate and controversy with regard to the most effective management of geriatric odontoid fractures. Also, functional outcomes, morbidity, and mortality rates for elderly patients who develop hypermobile nonunions after these fractures have not been clearly defined in the exisitng literature. PURPOSE: To evaluate fracture healing rates, functional outcomes, complications and mortality associated with rigid cervical collar and posterior fusion surgery for the management of geriatic type 2 odontoid fractures. STUDY DESIGN/SETTING: Prospective evaluation of 56 consecutive patients with type 2 odontoid fractures who were treated by the same fellowship- trained spinal trauma specialist at a level 1 trauma center PATIENT SAMPLE: 56 Consecutive geriatirc patients with type 2 odontoid fractures who presented to the same Level 1 trauma center and who were treated by the same fellowship-trained spinal trauma specialist. OUTCOME MEASURES: Neck Disability IndexVisual Analog Pain ScoreVisual Analog Satisfaction Score. METHODS: 56 consecutive elderly patients with type 2 odontoid fractures were treated by the same fellowship-trained spinal surgeon at a level 1 trauma center during an 8 year period. Patients with greater than 50% odontoid displacement were treated with C1-2 posterior fusion surgery. Patients with less than 50% odontoid displacement were treated with a rigid cervical collar for 12 weeks. Chart reviews were performed to obtain patient comorbidities, treatment complications, and mortality rates. At the time of ultimate follow-up, all patients had open mouth, flexion and extension radiographs to assess fracture stability and healing. Functional outcomes were assessed using Neck Disability Index (NDI), analog pain and satisfaction questionnaire scores. RESULTS: At average 14 month follow-up, fracture healing rates were higher in the operative group (28% vs 6%). 63% of the nonoperative patients had hypermobile nonunion versus 0% in the operative group. The average mobility of the nonunion was 2.5 mm (range 1-12 mm). NDI scores were lower in the nonoperative group (12.3 vs 18.3) indicating a trend toward less disability in the nonoperative group. There was also a trend toward lower analog pain scores were lower in the nonoperative group (1.3 vs 2.3). Satisfaction scores were equally high in both groups (9.1 vs 8.9). Hypermobile nonunion was not associated with lower outcomes scores. Mortality rate was 13% in the C-collar group and 21% in the operative group. Complications were higher in the operative group. CONCLUSIONS: Rates of odontoid facture healing and stability appear to be higher in geriatric patients treated with posterior fusion surgery. Fracture healing and stability did not coorelate with improved outcomes with respect to level of pain, function and satisfaction. Mortality and complication rates are lower in those patients who are treated with cervical collar immobilization.