Functional and quality-of-life outcomes in geriatric patients with type-ii dens fracture

Alexander R. Vaccaro, Christopher K. Kepler, Branko Kopjar, Jens Chapman, Christopher Shaffrey, Paul Arnold, Ziya Gokaslan, Darrel Brodke, John France, Mark Dekutoski, Rick Sasso, S. Tim Yoon, Christopher Bono, James Harrop, Michael G. Fehlings

Research output: Contribution to journalArticle

Abstract

Background: Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. Methods: One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables. Results: The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79%) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81%). The overall mortality rate was 18% over the twelve-month followup period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p <0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5% versus 21% in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26% and 14%, respectively; p = 0.059). Conclusions: We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)729-735
Number of pages7
JournalThe Journal of bone and joint surgery. American volume
Volume95
Issue number8
DOIs
StatePublished - Apr 17 2013

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Geriatrics
Quality of Life
Neck
Outcome Assessment (Health Care)
Therapeutics
Mortality
Prospective Studies
Social Adjustment
Confounding Factors (Epidemiology)
Arthrodesis
Immobilization
General Anesthesia
Multicenter Studies
Cohort Studies
Physicians
Pain

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Vaccaro, A. R., Kepler, C. K., Kopjar, B., Chapman, J., Shaffrey, C., Arnold, P., ... Fehlings, M. G. (2013). Functional and quality-of-life outcomes in geriatric patients with type-ii dens fracture. The Journal of bone and joint surgery. American volume, 95(8), 729-735. https://doi.org/10.2106/JBJS.K.01636

Functional and quality-of-life outcomes in geriatric patients with type-ii dens fracture. / Vaccaro, Alexander R.; Kepler, Christopher K.; Kopjar, Branko; Chapman, Jens; Shaffrey, Christopher; Arnold, Paul; Gokaslan, Ziya; Brodke, Darrel; France, John; Dekutoski, Mark; Sasso, Rick; Yoon, S. Tim; Bono, Christopher; Harrop, James; Fehlings, Michael G.

In: The Journal of bone and joint surgery. American volume, Vol. 95, No. 8, 17.04.2013, p. 729-735.

Research output: Contribution to journalArticle

Vaccaro, AR, Kepler, CK, Kopjar, B, Chapman, J, Shaffrey, C, Arnold, P, Gokaslan, Z, Brodke, D, France, J, Dekutoski, M, Sasso, R, Yoon, ST, Bono, C, Harrop, J & Fehlings, MG 2013, 'Functional and quality-of-life outcomes in geriatric patients with type-ii dens fracture', The Journal of bone and joint surgery. American volume, vol. 95, no. 8, pp. 729-735. https://doi.org/10.2106/JBJS.K.01636
Vaccaro, Alexander R. ; Kepler, Christopher K. ; Kopjar, Branko ; Chapman, Jens ; Shaffrey, Christopher ; Arnold, Paul ; Gokaslan, Ziya ; Brodke, Darrel ; France, John ; Dekutoski, Mark ; Sasso, Rick ; Yoon, S. Tim ; Bono, Christopher ; Harrop, James ; Fehlings, Michael G. / Functional and quality-of-life outcomes in geriatric patients with type-ii dens fracture. In: The Journal of bone and joint surgery. American volume. 2013 ; Vol. 95, No. 8. pp. 729-735.
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abstract = "Background: Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. Methods: One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables. Results: The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79{\%}) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81{\%}). The overall mortality rate was 18{\%} over the twelve-month followup period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p <0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5{\%} versus 21{\%} in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26{\%} and 14{\%}, respectively; p = 0.059). Conclusions: We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.",
author = "Vaccaro, {Alexander R.} and Kepler, {Christopher K.} and Branko Kopjar and Jens Chapman and Christopher Shaffrey and Paul Arnold and Ziya Gokaslan and Darrel Brodke and John France and Mark Dekutoski and Rick Sasso and Yoon, {S. Tim} and Christopher Bono and James Harrop and Fehlings, {Michael G.}",
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T1 - Functional and quality-of-life outcomes in geriatric patients with type-ii dens fracture

AU - Vaccaro, Alexander R.

AU - Kepler, Christopher K.

AU - Kopjar, Branko

AU - Chapman, Jens

AU - Shaffrey, Christopher

AU - Arnold, Paul

AU - Gokaslan, Ziya

AU - Brodke, Darrel

AU - France, John

AU - Dekutoski, Mark

AU - Sasso, Rick

AU - Yoon, S. Tim

AU - Bono, Christopher

AU - Harrop, James

AU - Fehlings, Michael G.

PY - 2013/4/17

Y1 - 2013/4/17

N2 - Background: Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. Methods: One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables. Results: The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79%) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81%). The overall mortality rate was 18% over the twelve-month followup period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p <0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5% versus 21% in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26% and 14%, respectively; p = 0.059). Conclusions: We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

AB - Background: Dens fractures are relatively common in the elderly. The treatment of Type-II dens fractures remains controversial. The aim of this multicenter prospective cohort study was to compare outcomes (assessed with use of validated clinical measures) and complications of nonsurgical and surgical treatment of Type-II dens fractures in patients sixty-five years of age or older. Methods: One hundred and fifty-nine patients with a Type-II dens fracture were enrolled in a multicenter prospective study. Subjects were treated either surgically (n = 101) or nonsurgically (n = 58) as determined by the treatment preferences of the treating physicians and the patients. The subjects were followed at six and twelve months with validated outcome measures, including the Neck Disability Index (NDI) and Short Form-36v2 (SF-36v2). Treatment complications were prospectively recorded. Statistical analysis was performed to compare outcome measures before and after adjustment for confounding variables. Results: The two groups were similar with regard to baseline characteristics. The most common surgical treatment was posterior C1-C2 arthrodesis (eighty of 101, or 79%) while the most common nonsurgical treatment was immobilization with use of a hard collar (forty-seven of fifty-eight, or 81%). The overall mortality rate was 18% over the twelve-month followup period. At twelve months, the NDI had increased (worsened) by 14.7 points in the nonsurgical cohort (p <0.0001) compared with a nonsignificant increase (worsening) of 5.7 points in the surgical group (p = 0.0555). The surgical group had significantly better outcomes as measured by the NDI and SF-36v2 Bodily Pain dimension compared with the nonsurgical group, and these differences persisted after adjustment. There was no difference in the overall rate of complications, but the surgical group had a significantly lower rate of nonunion (5% versus 21% in the nonsurgical group; p = 0.0033). Mortality was higher in the nonsurgical group compared with the surgical group (annual mortality rates of 26% and 14%, respectively; p = 0.059). Conclusions: We demonstrated a significant benefit with surgical treatment of dens fractures as measured by the NDI, a disease-specific functional outcome measure. As a result of the nonrandomized nature of the study, the results are vulnerable to the effects of possible residual confounding. We recommend that elderly patients with a Type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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