Functional outcomes, morbidity, mortality, and fracture healing in 26 consecutive geriatric odontoid fracture patients treated with posterior fusion. Molinari RW, Dahl J, Gruhn WL, Molinari WJ. Systematic review on surgical and nonsurgical treatment of type II odontoid fractures in the elderly. Deadly falls: operative versus nonoperative management of Type II odontoid process fracture in octogenarians. Graffeo CS, Perry A, Puffer RC, Carlstrom LP, Chang W, Mallory GW, Clarke MJ. C2 fracture subtypes, incidence, and treatment allocation change with age: a retrospective cohort study of 233 consecutive cases. Robinson A-L, Möller A, Robinson Y, Olerud C. The effect of the cervical orthosis on swallowing physiology and cervical spine motion during swallowing. Mekata K, Takigawa T, Matsubayashi J, Toda K, Hasegawa Y, Ito Y. Registered retrospectively on 25 August 2015.Įlderly Odontoid fractures Osteoporosis Spinal fractures Surgical treatment. Major limitations are (1) the allocation bias of the open-label study design, (2) that only higher training levels of all core specialties of spine surgery are included in the surgical treatment arm and (3) that only one type of surgical stabilisation is investigated (posterior C1-C2 fusion), while other methods are not included in this study.Ĭ, NCT02789774. Using the NDI and EQ-5D as endpoints, future value-based decisions may consider quality-adjusted life years gained. USOFT is the first randomised controlled trial comparing non-surgical and surgical management of type-2 odontoid fractures in the elderly. The secondary endpoints are: EQ-5D score, activities of daily living (ADL), bony union, upper cervical stability and mortality. The objective of this paper was to describe a case of traumatic posterior atlantoaxial dislocation. At 12 months, a dynamic radiographical investigation of upper cervical stability is performed. Traumatic posterior atlantoaxial dislocation without related fracture of the odontoid process is very rare, and only ten cases have been previously reported. All participants are monitored with regard to the NDI, EuroQol score (EQ-5D), socio-demographics and computed tomography (CT) at the time of injury, at 6 weeks, 3 months and 12 months. The surgical group is treated with a posterior C1-C2 fusion. The non-surgical group is fitted with a rigid cervical collar for 12 weeks. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. A minimum of 16 patients are needed in each group to test the superiority with 80% power. The minimal clinically important difference of the NDI is 3.5 points. Excluded are patients with an American Society of Anaesthesiologists (ASA) score ≥ 4, dementia nursing care or anatomical cervical anomalies. Fifty consecutive patients aged ≥ 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon. Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1-C2 fusion.
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