Functional outcomes, morbidity, mortality, and fracture healing in 26 consecutive geriatric odontoid fracture patients treated with posterior fusion

Robert William Molinari, Jason Dahl, William L Gruhn, William J Molinari
Journal of Spinal Disorders & Techniques 2013, 26 (3): 119-26

STUDY DESIGN: Retrospective review.

OBJECTIVE: To evaluate functional outcomes, fracture healing, complications, and mortality associated with posterior fusion surgery (PSF) for the management of geriatric type II odontoid fractures.

SUMMARY OF BACKGROUND DATA: Outcomes of C1-2 fusion for geriatric odontoid fractures are not well defined.

METHODS: Twenty-six consecutive elderly patients with type II odontoid fractures were treated by the same spinal surgeon at a Level-1 trauma center during an 8-year period. All patients had ≥50% odontoid displacement and were treated with PSF including C1-2 (PSF group; average age, 79 y). Chart reviews were performed evaluating patient comorbidities, treatment complications, and mortality rates. At ultimate follow-up, patients had open mouth, flexion, and extension radiographs to assess fracture stability and healing. In addition, functional outcomes were assessed using Neck Disability Index (NDI), analog pain, and satisfaction questionnaire scores and compared with a group of 40 aged-matched control patients (control group; average age, 79.8 y).

RESULTS: The mortality rate was 19.2%, and major complications occurred in 27% of patients. At an average 13-month follow-up (range, 3-48 mo), the fracture-healing rate was only 33%. However, no patient had mobile odontoid nonunion or instability of the C1-2 articulation. NDI scores averaged 18.1 points indicating only mild residual disability. Pain scores were low averaging only 1.8 points. NDI and pain scores did not differ significantly from aged-matched controls (P = 0.16). Treatment satisfaction scores were high. Odontoid nonunion was not associated with significantly higher levels of disability or neck pain and did not affect scores for patient satisfaction.

CONCLUSIONS: PSF for geriatric odontoid fractures is associated with moderately high levels of morbidity and mortality. Posttreatment neck pain and disability is low and does not differ significantly from aged-matched cohorts. Odontoid fracture healing after surgical stabilization does not correlate with improved functional outcomes.

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