Yann Philippe Charles1, Yves Ntilikina2, Benjamin Blondel3, Stéphane Fuentes3, Jérémy Allia4, Nicolas Bronsard4, Maxime Lleu5, Benjamin Nicot6, Vincent Challier7, Joël Godard8, Pascal Kouyoumdjian9, Nicolas Lonjon10, Paulo Marinho11, Julien Berthiller12, Eurico Freitas13, Cédric Barrey13. 1. Service de chirurgie du rachis, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France. yann.philippe.charles@chru-strasbourg.fr. 2. Service de chirurgie du rachis, Hôpitaux Universitaires de Strasbourg, 1 place de l'Hôpital, BP 426, 67091, Strasbourg Cedex, France. 3. Unité de chirurgie du rachis, Université Aix-Marseille, CHU Timone, 264 rue Saint-Pierre, 13005, Marseille, France. 4. Unité de Chirurgie Rachidienne, Institut Universitaire de l'appareil Locomoteur et du Sport, Hôpital Pasteur 2, CHU de Nice, 30 voie Romaine, 06001, Nice, France. 5. Service de neurochirurgie, CHU de Dijon, 14 rue Paul Gaffarel, 21000, Dijon Cedex, France. 6. Département de neurochirurgie, CHU de Grenoble, avenue Maquis-du-Grésivaudan, 38700, La Tronche, France. 7. Unité d'orthopédie-traumatologie rachis I, Hôpital Tripode, CHU de Bordeaux, Place Amélie-Raba-Léon, 33076, Bordeaux cedex, France. 8. Service de neurochirurgie, Hôpital Jean-Minjoz, 3 boulevard A Fleming, 25030, Besançon Cedex, France. 9. Service d'orthopédie-traumatologie, CHU de Nîmes, avenue du Pr Debré, 30000, Nîmes, France. 10. Service de neurochirurgie, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34090, Montpellier, France. 11. Service de neurochirurgie, Hôpital Roger-Salengro, CHRU de Lille, rue Emile-Laine, 59037, Lille, France. 12. Pôle IMER, Hospices Civils de Lyon, 162 avenue Lacassagne, 69424, Lyon Cedex 03, France. 13. Service de neurochirurgie C et chirurgie du rachis, Hôpital P Wertheimer, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, 59 boulevard Pinel, 69003, Lyon, France.
Abstract
PURPOSE: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment. METHODS: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D'Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation. RESULTS: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment. CONCLUSIONS: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.
PURPOSE: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment. METHODS: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D'Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation. RESULTS: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment. CONCLUSIONS: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.