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Surgical Stabilization Beneficial for Odontoid Fractures

Mortality rate lower at 30 days and one year in propensity score-matched and Cox proportional hazards analyses

By Elana Gotkine HealthDay Reporter

WEDNESDAY, Aug. 9, 2023 (HealthDay News) — For patients with odontoid fractures, surgical stabilization is associated with a reduced rate of nonunion and mortality at 30 days and one year, according to a study published online June 12 in Neurosurgery.

Michael Cloney, M.D., from the Northwestern University Feinberg School of Medicine in Chicago, and colleagues examined the effect of surgical fixation on myelopathy, fracture nonunion, and mortality after odontoid fractures in a cohort of 303 patients managed at a single institution between 2010 and 2020. Of the participants, 21.6 percent underwent surgical stabilization. The effect on nonunion and mortality was examined using propensity score analysis.

The researchers found that the overall rate of nonunion was lower in the surgical group (39.7 versus 57.3 percent; average treatment effect [ATE], −0.153) after controlling for age and fracture angulation, type, comminution, and displacement. The mortality rate was lower for the surgical group at 30 days (1.7 versus 13.8 percent; ATE, −0.101) and at one year (7.0 versus 23.7 percent; ATE, −0.099) after controlling for age, sex, Nurick score, Charlson Comorbidity Index, Injury Severity Score, and selection for intensive care unit admission. A mortality benefit for surgery was also seen in a Cox proportional hazards analysis (hazard ratio, 0.587). The likelihood of having worse myelopathy scores at follow-up was lower for patients who underwent surgery (odds ratio, 0.48).

“Our study represents a relatively large institutional series that suggests a benefit from surgical stabilization in this population while controlling for confounding factors more thoroughly than existing literature,” the authors write.

One author disclosed ties to Depuy Spine.

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