Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture.

dc.contributor.author

Vaccaro, Alexander R

dc.contributor.author

Kepler, Christopher K

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Kopjar, Branko

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Chapman, Jens

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Shaffrey, Christopher

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Arnold, Paul

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Gokaslan, Ziya

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Brodke, Darrel

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France, John

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Dekutoski, Mark

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Sasso, Rick

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Yoon, S Tim

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Bono, Christopher

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Harrop, James

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Fehlings, Michael G

dc.date.accessioned

2023-08-29T23:50:52Z

dc.date.available

2023-08-29T23:50:52Z

dc.date.issued

2013-04

dc.date.updated

2023-08-29T23:50:52Z

dc.description.abstract

Background

Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older.

Methods

One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables.

Results

The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79%) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81%). The overall mortality rate was 18% over the twelve-month follow-up period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p < 0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5% versus 21% in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26% and 14%, respectively; p = 0.059).

Conclusions

We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates.
dc.identifier

1674741

dc.identifier.issn

0021-9355

dc.identifier.issn

1535-1386

dc.identifier.uri

https://hdl.handle.net/10161/28834

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

The Journal of bone and joint surgery. American volume

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10.2106/jbjs.k.01636

dc.subject

Odontoid Process

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Humans

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Spinal Fractures

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Treatment Outcome

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Spinal Fusion

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Cohort Studies

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Immobilization

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Age Factors

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Recovery of Function

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Quality of Life

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Aged

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Female

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Male

dc.title

Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

729

pubs.end-page

735

pubs.issue

8

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

95

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