A cohort study of the natural history of odontoid pseudoarthrosis managed non-operatively in the elderly.

A cohort study of the natural history of odontoid pseudoarthrosis managed non-operatively in the elderly.

World Neurosurg. 2018 Mar 26;:

Authors: Hong J, Zaman R, Coy S, Pastel D, Simmons N, Ball P, Mirza S, Abdu W, Pearson A, Lollis S

Abstract
OBJECTIVE: While the primary goal of treatment of type II odontoid fracture is bony union, some advocate continued non-surgical management of minimally symptomatic older patients who have fibrous union or minimal fracture motion. The risk of this strategy is unknown. We reviewed our long-term outcomes following dens nonunion in order to define the natural history of type II odontoid fractures in the elderly managed non-operatively.
METHODS: Retrospective chart review of 50 consecutive adults aged 65 or older with type II odontoid fracture initially managed non-surgically from 1998-2012 at a single tertiary care institution was conducted. Particular attention was paid to patients who had orthosis removal despite absent bony fusion. Patients were prospectively contacted by telephone and followed until death, surgical intervention, or last known contact.
RESULTS: Fifty patients were initially managed non-surgically; of these, 21 (42.0%) proceeded to bony fusion, 3 (6%) underwent delayed surgery for persistent instability, and 26 (52 %) had orthosis removal despite the lack of solid arthrodesis on imaging. The last group had a median follow-up of 25 months (range 4-158 months), with 20 of 26 (76.9%) followed until death. Of these patients, one patient developed progressive quadriplegia and dysphagia 11 months after initial injury. Compared to patients with spontaneous union, patients with nonunion had shorter life expectancy, despite no significant differences between the groups with respect to age, gender, injury mechanism, radiographic variables, or follow-up duration.
CONCLUSIONS: Orthosis removal despite fracture nonunion may be reasonable in elderly patients with Type II dens fractures.

PMID: 29597016 [PubMed - as supplied by publisher]

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