• Benjamin Pommier, Edouard Ollier, Jean-Baptiste Pelletier, Xavier Castel, François Vassal, and Marie-Charlotte Tetard.
• Service de Neurochirurgie, CHU de Saint Etienne, Saint Etienne, France; INSERM U1028, ICD, Université Jean Monnet, Saint Etienne, France. Electronic address: Benjamin.Pommier@Neurochirurgie.fr.
• World Neurosurg. 2020 Sep 1; 141: 490-499.e2.

BackgroundOdontoid fracture is a common injury especially in elderly people. Despite some recent studies arguing in favor of surgery, the best treatment is still being debated.ObjectiveWe systematically review and analyze the comparative literature between surgical and conservative treatments of odontoid fractures.MethodsWe systematically searched Medline and the Cochrane Library for studies reported from January 1990 to May 2019 in English. Comparative studies evaluating the results of surgical and conservative treatments for odontoid fractures were eligible for inclusion. Combined relative risks (RRs) for mortality at last follow-up, union or nonunion rates, and complications were calculated. Methodological quality was assessed using the Newcastle-Ottawa Scale. Influence of age and year of publication on treatment effect was explored using a meta-regression analysis.ResultsA total of 1438 articles were identified, of which 30 articles with 2463 patients were eligible for inclusion. There was a trend toward lower mortality in the surgical group (RR, 0.80; 95% confidence interval [CI], 0.63-1.02). Nonunion rates (RR, 0.41; 95% CI, 0.28-0.6) were lower in the surgical group. Union rates were higher in the surgical group (RR, 1.26; 95% CI, 1.11-1.45). No significant influence of age or year of publication on treatment effect was found.ConclusionsBased on this meta-analysis of nonrandomized comparative studies, surgical treatment seems not to be inferior to conservative treatments. The conclusions of this study remain limited by the low quality of the evidence available. Randomized controlled studies are required.Copyright © 2020 Elsevier Inc. All rights reserved.

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