All participants are monitored with regard to the NDI, EuroQol score (EQ-5D), socio-demographics and computed tomography (CT) at the time of injury, at 6 weeks, 3 months and 12 months. The surgical group is treated with a posterior C1–C2 fusion. The non-surgical group is fitted with a rigid cervical collar for 12 weeks. By considering a 1-year mortality forecast of 29%, up to 25 participants are recruited in each group. A minimum of 16 patients are needed in each group to test the superiority with 80% power. The minimal clinically important difference of the NDI is 3.5 points. Excluded are patients with an American Society of Anaesthesiologists (ASA) score ≥ 4, dementia nursing care or anatomical cervical anomalies. Fifty consecutive patients aged ≥ 75 years, with displaced type-2 odontoid fracture, are randomised to non-surgical or surgical treatment. The Uppsala Study on Odontoid Fracture Treatment (USOFT) is a multicentre, open-label, randomised controlled superiority trial evaluating the clinical superiority of the surgical treatment of type-2 odontoid fractures, with a 1-year Neck Disability Index (NDI) as the primary endpoint. Due to the paucity of evidence, the treatment decision is often left to the discretion of the expert surgeon. Poor outcome is associated with spinal cord injury, GCS score, AIS score, and ISS.ĪIS = Abbreviated Injury Scale GCS = Glasgow Coma Scale ISS = Injury Severity Score SCI = spinal cord injury Type II odontoid fracture cervical elderly populations nonoperative management spine trauma.Displaced odontoid fractures in the elderly are treated non-surgically with a cervical collar or surgically with C1–C2 fusion. CONCLUSIONS Type II odontoid fracture is associated with high morbidity among octogenarians, with 41% 1-year mortality independent of intervention-a dramatic decrease from actuarial survival rates for all 80-, 90-, and 100-year-old Americans. The rate of nonhome disposition was not significant between the groups. Additional cervical fracture was not associated with increased mortality. Spinal cord injury, GCS score, AIS score, and ISS were significantly associated with 30-day and 1-year mortality however, Cox modeling was not significant for any variable. Kaplan-Meier analysis did not demonstrate a survival advantage for either management strategy. Nonoperative and operative mortality rates were not significant at any time point (12% vs 18%, p = 0.5 27% vs 24%, p = 0.8 and 41% vs 41%, p = 1.0 ). Overall mortality was 13% in-hospital, 26% at 30 days, and 41% at 1 year. The mean time to death or last follow-up was 22 months (range 0-129 months) and was nonsignificant between operative and nonoperative groups (p = 0.3). Additional cervical fracture, spinal cord injury, GCS score, AIS score, and ISS were not associated with either management strategy at the time of presentation. The mean age was 87 years (range 80-104 years). Mortality data were available for 100% of patients. RESULTS A total of 111 patients met inclusion criteria (94 nonoperative and 17 operative ). Statistical tests included the Student t-test, chi-square test, Fisher's exact test, Kaplan-Meier test, and Cox proportional hazard. Primary end points were mortality at 30 days and at 1 year. Prospectively recorded outcomes included Glasgow Coma Scale (GCS) score, Abbreviated Injury Scale (AIS) score, Injury Severity Score (ISS), additional cervical fracture, and cord injury. Cervical CT images were independently reviewed by blinded neurosurgeons to confirm a Type II fracture pattern. METHODS A single-center prospectively maintained trauma database was reviewed using ICD-9 codes to identify octogenarians with C-2 cervical fractures between 19. The authors compared operative and nonoperative management in patients older than 79 years. Previous studies have demonstrated a survival advantage following early surgery among patients older than 65 years, yet octogenarians represent a medically distinct and rapidly growing population. OBJECTIVE Type II odontoid fracture is a common injury among elderly patients, particularly given their predisposition toward low-energy falls.
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