Functional and Radiographic Outcomes of Geriatric Odontoid Fractures Treated with Rigid Collar or Posterior Fusion

INTRODUCTION: Controversy exists as to the most effective management option for elderly patients with type II odontoid fractures. Furthermore, outcomes for those patients who do not achieve fusion or fracture healing after treatment remain unclear in the literature. The purpose of this study is to evaluate fracture healing rates, functional outcomes, complications, and mortality associated with rigid cervical collar and posterior fusion surgery for the management of geriatric type II odontoid fractures. METHODS: Fifty-eight consecutive elderly patients with type II odontoid fractures were treated by the same fellowship-trained spinal surgeon at a level 1 trauma center during an eight-year period. Patients with greater than 50% odontoid displacement were treated with posterior fusion surgery including C1-2 (PSF Group, n= 25, Ave age = 80 yrs). Patients with less than 50% odontoid displacement were treated with a rigid cervical collar for 12 weeks (Collar Group, n=33, Ave age = 83 yrs). Chart reviews were performed evaluating patient comorbidities, treatment complications, and mortality rates. At the time of ultimate follow up, patients had open mouth, flexion and extension radiographs to assess fracture stability and healing. Additionally, functional outcomes were assessed using Neck Disability Index (NDI), analog pain and satisfaction questionnaire scores. RESULTS: At average 14 month follow up (range 3-48 months), fracture healing rates were higher in the operative group (28% vs 6%). A total of 64% of the nonoperative patients had mobile nonunion versus 0% in the operative group. The average mobility of the nonunion was 2.5mm (range 1-12mm). NDI scores were lower in the nonoperative group (13 vs. 18.3) indicating a trend toward less disability in the nonoperative group (p=0.23). There was also a trend toward lower analog pain scores in the nonoperative group (1.3 vs. 1.9, p=0.26). Satisfaction scores were equally high in both groups (9.1 vs. 8.9). Mobile odontoid nonunion was not associated with higher levels of disability or neck pain, and did not affect scores for patient satisfaction. Mortality rate was 12.5% in the C-collar group and 20% in the operative group. Complications were higher in the operative group (24% vs 6%) (Table 1, Figure 1). DISCUSSION AND CONCLUSION: Rates of type II odontoid facture healing and stability appear to be higher in geriatric patients treated with posterior fusion surgery. Fracture healing and stability did not correlate with improved outcomes with respect to levels of pain, function and satisfaction. Mortality and complication rates are lower in those patients who are treated with a cervical collar and early mobilization. SPINE