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Risk factors for early mortality in elderly patients with unstable isolated C2 odontoid fracture treated with halo-vest or surgery.

ABSTRACT: The aim of this study was to compare in-hospital mortality of three procedures -halo-vest immobilization, anterior spinal fixation (ASF), and posterior spinal fixation (PSF)- in the treatment of elderly patients with isolated C2 odontoid fracture. We extracted data for elderly patients who were admitted with C2 odontoid fracture and treated with at least one of the three procedures (halo-vest immobilization, ASF, or PSF) during hospitalization. We conducted a generalized propensity score-based matching weight analysis to compare in-hospital mortality among the three procedures. We further investigated independent risk factors for in-hospital death. The study involved 891 patients (halo-vest, n = 463; ASF, n = 74; and PSF, n = 354) with a mean age of 78 years. In-hospital death occurred in 45 (5.1%) patients. Treatment type was not significantly associated with in-hospital mortality. Male sex (odds ratio 2.98; 95% confidence interval 1.32-6.73; p = 0.009) and a Charlson comorbidity index of ≥ 3 (odds ratio 9.18; 95% confidence interval 3.25-25.92; p < 0.001) were independent risk factors for in-hospital mortality. In conclusion, treatment type was not significantly associated with in-hospital mortality in elderly patients with isolated C2 odontoid fracture. Halo-vest immobilization can help to avoid adverse events in patients with C2 odontoid fracture who are considered less suitable for surgical treatment.

SUBMITTER: Honda A

PROVIDER: S-EPMC10589273 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Risk factors for early mortality in elderly patients with unstable isolated C2 odontoid fracture treated with halo-vest or surgery.

Honda Akira A Iizuka Yoichi Y Michihata Nobuaki N Morita Kojiro K Mieda Tokue T Takasawa Eiji E Ishiwata Sho S Kakuta Yohei Y Tomomatsu Yusuke Y Ito Shunsuke S Inomata Kazuhiro K Matsui Hiroki H Fushimi Kiyohide K Yasunaga Hideo H Chikuda Hirotaka H

Scientific reports 20231020 1

The aim of this study was to compare in-hospital mortality of three procedures -halo-vest immobilization, anterior spinal fixation (ASF), and posterior spinal fixation (PSF)- in the treatment of elderly patients with isolated C2 odontoid fracture. We extracted data for elderly patients who were admitted with C2 odontoid fracture and treated with at least one of the three procedures (halo-vest immobilization, ASF, or PSF) during hospitalization. We conducted a generalized propensity score-based m ...[more]

PMID: 37864100

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Project description:The WHO definition of osteoporosis excludes cervical fractures. Recent studies suggest that atraumatic odontoid fractures (OF) may be favored by osteoporosis but global bone status for osteoporosis diagnosis has not been described. We present a case series of patients >65 years old hospitalized for low-energy OF who had an evaluation of their bone status within 3 months after fracture, including clinical risk factors of osteoporosis, bone mineral density (BMD), vertebral fracture assessment (VFA) by dual X-ray absorptiometry, and laboratory tests. Osteoporosis was defined as a T-score ≤ -2.5 on at least one site, or a bone fragility fracture associated with a T-score ≤ -1 at one site. Thirty-three patients were hospitalized for OF, 30 of them as a consequence of a low-energy impact: 20 women and 10 men (mean age: 85 years). Eight patients died before bone evaluation, four refused, and six were lost to follow-up. Twelve patients were included: 11 women and one man (mean age: 83.8 years). Ten out of twelve patients fulfilled diagnostic criteria of osteoporosis, including eight with previous osteoporotic fractures (six severe fractures). Eight fulfilled specific treatment of osteoporosis criteria, but only two were treated. The mean follow-up period was 12.2 ± 4.1 months. Prior to OF occurrence, all lived at home and were independent; at the time of discharge, six went to a nursing home. At 3 months of follow-up (n = 10), one was dead and nine lived at home. At 12 months (n = 9), two were dead and seven lived at home. This study provides for the first time a classical evaluation of osteoporotic status for low-energy OF in the elderly and shows that it occurs in osteoporotic subjects. These preliminary results require larger-scale studies to determine whether OF could be considered as a severe osteoporotic fracture. © 2018 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

Project description:BackgroundTeardrop fracture of the axis (TDFA) is rare in cervical injuries. The treatment for TDFA is controversial, and few prior studies exist. C2-3 fusion with internal fixation could provide anterior support and ensure immediate stability. The aim of this study was to evaluate the clinical outcome of anterior C2-3 fusion with internal fixation for unstable TDFA.MethodsFifteen patients with unstable TDFA were treated by anterior C2-3 fusion with internal fixation between October 2012 and June 2018. Radiological parameters, including the avulsed ratio of the inferior endplate of the axis, the average rotation angle, and the displacement of the avulsed fragment, were measured before the operation. Clinical parameters, including the visual analogue scale (VAS) and the Neck Disability Index (NDI), were assessed before the operation; 3 days, 1 month, and 3 months after the operation; and at the final follow-up. Perioperative complications were also recorded.ResultsThe mean follow-up time was 42.4 months (24-60 months). The mean operation time was 81.0 minutes (62-104 minutes), and the intraoperative blood loss was 61.3 mL (30-100 mL). Two patients complained of mild dysphagia after the operation and recovered at postoperative 1 month. Two patients classified as American Spinal Injury Association (ASIA) impairment scale grade D both improved to ASIA grade E postoperatively. The VAS score decreased from a preoperative value of 8.2±1.2 to a postoperative value of 1.7±0.9 (P<0.001), and maintained at 1.5±0.6 at last follow-up (P=0.51). The NDI score decreased from a preoperative value of 79.3±14.1 to a postoperative value of 16.5±4.3 (P<0.001), and maintained at 17.1±4.6 at last follow-up (P=0.62). No loosening or rupture of implantation was observed during the follow-up period. Bony union and fusion were achieved in all patients.ConclusionsThe clinical and radiological outcomes of anterior C2-3 fusion with internal fixation for the treatment of unstable TDFA were satisfactory. Anterior C2-3 fusion with internal fixation could be considered as a safe and effective method for managing TDFA.

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Risk factors for early mortality in elderly patients with unstable isolated C2 odontoid fracture treated with halo-vest or surgery.

Publications

Risk factors for early mortality in elderly patients with unstable isolated C2 odontoid fracture treated with halo-vest or surgery.

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