• Michael Cloney, Vineeth Thirunavu, Anastasios Roumeliotis, Hooman Azad, Nathan A Shlobin, Kevin Swong, Najib El Tecle, and Nader S Dahdaleh.
• Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago , Illinois , USA.
• Neurosurgery. 2023 Sep 1; 93 (3): 546554546-554.

BackgroundExisting literature suggests that surgical intervention for odontoid fractures is beneficial but often does not control for known confounding factors.ObjectiveTo examine the effect of surgical fixation on myelopathy, fracture nonunion, and mortality after traumatic odontoid fractures.MethodsWe analyzed all traumatic odontoid fractures managed at our institution between 2010 and 2020. Ordinal multivariable logistic regression was used to identify factors associated with myelopathy severity at follow-up. Propensity score analysis was used to test the treatment effect of surgery on nonunion and mortality.ResultsThree hundred and three patients with traumatic odontoid fracture were identified, of whom 21.6% underwent surgical stabilization. After propensity score matching, populations were well balanced across all analyses (Rubin's B < 25.0, 0.5 < Rubin's R < 2.0). Controlling for age and fracture angulation, type, comminution, and displacement, the overall rate of nonunion was lower in the surgical group (39.7% vs 57.3%, average treatment effect [ATE] = -0.153 [-0.279, -0.028], P = .017). Controlling for age, sex, Nurick score, Charlson Comorbidity Index, Injury Severity Score, and selection for intensive care unit admission, the mortality rate was lower for the surgical group at 30 days (1.7% vs 13.8%, ATE = -0.101 [-0.172, -0.030], P = .005) and at 1 year was 7.0% vs 23.7%, ATE = -0.099 [-0.181, -0.017], P = .018. Cox proportional hazards analysis also demonstrated a mortality benefit for surgery (hazard ratio = 0.587 [0.426, 0.799], P = .0009). Patients who underwent surgery were less likely to have worse myelopathy scores at follow-up (odds ratio = 0.48 [0.25, 0.93], P = .029).ConclusionSurgical stabilization is associated with better myelopathy scores at follow-up and causes lower rates of fracture nonunion, 30-day mortality, and 1-year mortality.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.

22 keywords...

hide…