Huybregts Jeroen G J, Polak Samuel B, Jacobs Wilco C H, Krekels-Huijbregts Ilse A, Smeets Anouk Y J M, Arts Mark P, Slooff Willem-Bart M, Öner F Cumhur, Peul Wilco C, van Santbrink Henk, Vleggeert-Lankamp Carmen L A
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland, Leiden, The Netherlands.
Department of Neurosurgery, Haaglanden Medical Center, University Neurosurgical Center Holland, The Hague, The Netherlands.
Global Spine J. 2025 Mar;15(2):490-497. doi: 10.1177/21925682231194818. Epub 2023 Aug 8.
Retrospective cohort study.
Odontoid fractures are the most common cervical spine fractures in the elderly. The optimal treatment remains controversial. The aim of this study was to compare results of a low-threshold-for-surgery strategy (surgery for dislocated fractures in relatively healthy patients) to a primarily-conservative strategy (for all patients).
Patient records from 5 medical centers were reviewed for patients who met the selection criteria (e.g. age ≥55 years, type II/III odontoid fractures). Demographics, fracture types/characteristics, fracture union/stability, clinical outcome and mortality were compared. The influence of age on outcome was studied (≥55-80 vs ≥80 years).
A total of 173 patients were included: 120 treated with low-threshold-for-surgery (of which 22 primarily operated, and 23 secondarily) vs 53 treated primarily-conservative. No differences in demographics and fracture characteristics between the groups were identified. Fracture union (53% vs 43%) and fracture stability (90% vs 85%) at last follow-up did not differ between groups. The majority of patients (56%) achieved clinical improvement compared to baseline. Analysis of differences in clinical outcome between groups was infeasible due to data limitations. In both strategies, patients ≥80 years achieved worse union (64% vs 30%), worse stability (97% vs 77%), and - as to be expected - increased mortality <104 weeks (2% vs 22%).
Union and stability rates did not differ between the treatment strategies. Advanced age (≥80 years) negatively influenced both radiological outcome and mortality. No cases of secondary neurological deficits were identified, suggesting that concerns for the consequences of under-treatment may be unjustified.
回顾性队列研究。
齿状突骨折是老年人中最常见的颈椎骨折。最佳治疗方法仍存在争议。本研究的目的是比较低手术阈值策略（对相对健康的脱位骨折患者进行手术）与主要保守策略（对所有患者）的结果。
回顾了5个医疗中心符合入选标准（如年龄≥55岁，II/III型齿状突骨折）患者的病历。比较了人口统计学、骨折类型/特征、骨折愈合/稳定性、临床结局和死亡率。研究了年龄对结局的影响（≥55 - 80岁与≥80岁）。
共纳入173例患者：120例采用低手术阈值治疗（其中22例初次手术，23例二次手术），53例主要采用保守治疗。两组在人口统计学和骨折特征方面未发现差异。末次随访时骨折愈合率（53%对43%）和骨折稳定性（90%对85%）在两组间无差异。与基线相比，大多数患者（56%）临床症状改善。由于数据限制，分析两组间临床结局的差异不可行。在两种策略中，≥80岁的患者骨折愈合情况较差（64%对30%），稳定性较差（97%对77%），且不出所料，<104周时死亡率增加（2%对22%）。
治疗策略之间的骨折愈合率和稳定性无差异。高龄（≥80岁）对放射学结局和死亡率均有负面影响。未发现继发性神经功能缺损病例，这表明对治疗不足后果的担忧可能没有依据。
