Comparison of outcomes in the management of Type II odontoid fractures in young patients - Is surgery overrated?

Abstract

Introduction: The options for the management of type II odontoid fractures in young patients include anterior screw fixation, posterior spinal fusion, or halo-vest immobilization (HVI). However, there is a recent trend away from nonoperative management and an increase in primary operative stabilization across several centers. Hence, our study aims to compare the functional and radiological outcomes of type II odontoid fractures in young patients managed with HVI and surgery.

Materials and methods: A retrospective analysis of 70 patients with type II odontoid fracture who were managed in our institution with a mean age of 47 years was included in our study. The clinical details included the Neck Disability Index (NDI), Visual Analog Scale (VAS) for neck pain, and S-Range of Movement (ROM)-Neck score. Radiological details included union status, atlanto-dens interval, amount of displacement and angulation, and transverse ligament injury. Both the clinical and radiological parameters were compared between the patients who underwent HVI (n = 28) and surgery (n = 42).

Results: The mean ± standard deviation follow-up duration was 4.2 ± 2.5 years in the HVI group and 3.8 ± 2.7 years in the surgery group. Of the clinical parameters, the S-ROM-Neck score was significantly better in the HVI group than in the surgery group (P < 0.001). The length of hospitalization was much shorter in the HVI group (P < 0.001). There were no differences in NDI, VAS for neck pain, and other radiological parameters.

Conclusion: For type II odontoid fractures in young patients, HVI had better clinical outcomes compared to the surgery and should be considered the first line of management.