Functional and Quality of Life Outcomes in Geriatric Patients with Type II Odontoid Fracture: One Year Results from the AOSpine North America Multi-Center GOF Prospective Study

Branko Kopjar1, Michael Fehlings, MD1, Alexander Vaccaro, MD1, Jens Chapman, MD1, Christopher Shaffrey, MD1, Paul Arnold, MD1, Ziya Gokaslan, MD1, Darrel Brodke, MD1, John France, MD1, Sangwook Yoon, MD1, Mark Dekutoski, MD1, Rick Sasso, MD1, Christopher Bono, MD1

1Seattle, WA United States

Keywords: quality of life, elderly, odontoid, fracture, outcome

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Abstract

     There is a controversy whether surgery or conservative management is the best treatment option for geriatric odontoid fractures.  
     Our purpose was to study functional outcomes in elderly patients.
     Prospective multi-center cohort study of subjects < 65 yrs old with Type II odontoid fracture at 11 sites in North America.
     Patients received nonoperative or surgical treatment at the discretion of the surgical team and were followed for 12 months.
     Of 159 subjects (average age: 80.7 (SD 7.5); 59.8% females) 63.5% were treated operatively (11.9% anterior odontoid screw; 79.2% posterior C1- C2screw fixation; 6.9% posterior transarticular screw fixation ; 1.0% Brooks Fusion and 1.0% Occipital-Cervical Fusion). 29 (18.2%) expired and 3 withdrew from the study. Follow-up was available for 103 (79.2%) of 130 eligible, surviving subjects. Baseline NDI was 21.7(SD 17.2) and SF36v2 PCS was 40.7 (SD 10.5). At 12 months, NDI worsened by 7.6 (SD 21.0) points (P < .001) and SF36v2 PCS declined by 1.6 (SD 11.1) points (P = .019). There was a significant difference in NDI outcomes between the surgically and the conservatively treated groups. The decline in NDI among the surgical cases was 5.6 points compared to 14.7 points in the conservatively treated group (P = .0173). There were no differences inSF36v2 PCS outcomes between the treatment groups.
     This is a collection of prospective data but is not randomized.
     Elderly patients with type II odontoid fracture experience significant mortality and decline in functional outcomes at one year follow-up.
     Our results do suggest that NDI outcomes may be better in the surgical group, though the possibility of selection bias needs to be carefully considered.


Acknowledgements

Project Roles:

B. Kopjar (), M. Fehlings (), A. Vaccaro (), J. Chapman (), C. Shaffrey (), P. Arnold (), Z. Gokaslan (), D. Brodke (), J. France (), S. Yoon (), M. Dekutoski (), R. Sasso (), C. Bono ()