Surgical Intervention Versus Cervical Collar Treatment of Displaced Type II Odontoid Fractures in the Elderly: A Randomized Controlled Trial.

Abstract

The treatment of displaced odontoid type II fractures in the elderly is controversial. The objective of this study was to compare surgical intervention with cervical collar treatment. This open-label, randomized controlled superiority trial included neurologically intact participants 75 years and older with displaced odontoid type II fractures, randomized to posterior C1-C2 surgery or cervical collar treatment. The primary outcome was Neck Disability Index (NDI) at the 1 year follow-up. Secondary outcomes included the EuroQol 5 Dimensions (EQ-5D) index, EuroQol-visual analogue scale, radiological data and mortality. Between-group comparisons used the Mann-Whitney U test; within-group comparisons used the Wilcoxon signed-rank test. Multiple imputation was used to account for missing data in NDI and EQ-5D index. Forty-seven participants (25 surgical group, 22 cervical collar group) were randomized. Median [IQR] baseline NDI was 40% [18%-60%] in the surgical group and 44% [27%-65%] in the cervical collar group. At 1 year, NDI was 24% [5%-33%] in the surgical group and 34% [8%-50%] in the cervical collar group (P = .29 for group comparison, and P = .028 and P = .16 for within group change, respectively). Median EQ-5D index at 1 year was 0.71 [0.39-0.94] and 0.62 [0.195-1], and EuroQol-visual analogue scale was 70 [45-77.5] and 60 [37.5-75]. Bony union and radiological stability were more frequent in the surgical group. One year mortality was 7 and 3 participants, respectively (P = .3). Surgical intervention was not superior to treatment with a cervical collar for displaced type II odontoid fractures.