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Odontoid Fractures With Neurologic Deficit Have Higher Mortality and Morbidity

  • Symposium: Complications of Spine Surgery
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Type II odontoid fractures are reportedly increasing in incidence and occur primarily in the elderly. Neurologic deficits (ND) at presentation add to the morbidity of these fractures; however, reports are limited as a result of small case series. It is unclear what specific complications are associated with ND and whether these result in increased incidence of mortality.

Questions/purposes

We established the incidence of ND with Type II odontoid fractures and determined if ND are associated with increased inpatient mortality and morbidity during hospitalization.

Methods

Twenty patients with acute Type II odontoid fracture and ND were identified from our institutional database. Baseline presenting characteristics and hospital course data were collected. The cohort was compared with a previously published cohort of 188 patients without ND by age, mechanism of injury, displacement, associated spinal injuries, comorbidities, treatment, mortality, and complications. Patients were only followed during acute-care hospitalization (mean, 11.9 days; range, 0–41 days).

Results

The incidence of ND among all Type II odontoid fractures was 9.6%. Ten of 20 patients with Type II odontoid fractures and ND died during hospitalization, and patients with complete cord injuries were 9.33 (95% confidence interval, 1.19–73.0) times more likely to die. Patients with ND experienced more complications and more respiratory complications than those without ND.

Conclusions

ND after Type II odontoid fractures is a rare event associated with a high risk of early and rapid clinical decline.

Level of Evidence

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Martin E. Griffis, BA, from Temple University for his assistance in data collection and Mitchell Maltenfort, PhD, from the Department of Neurosurgery at Thomas Jefferson University Hospital for his assistance in statistical analysis for this study.

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Authors and Affiliations

  1. Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA

    Amar Patel BS & Navin Yadlapalli BS

  2. New England Orthopaedic and Spine Surgery, New England Baptist Hospital, Tufts University, 830 Boylston Street, Suite 211, Chestnut Hill, Boston, MA, 02467, USA

    Harvey E. Smith MD

  3. Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA

    Kris Radcliff MD & Alexander R. Vaccaro MD, PhD

  4. Department of Orthopaedics, Rothman Institute, Philadelphia, PA, USA

    Kris Radcliff MD & Alexander R. Vaccaro MD, PhD

Authors
  1. Amar Patel BS
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  2. Harvey E. Smith MD
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  3. Kris Radcliff MD
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  4. Navin Yadlapalli BS
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  5. Alexander R. Vaccaro MD, PhD
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Corresponding author

Correspondence to Harvey E. Smith MD.

Additional information

Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

This work was performed at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.

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Patel, A., Smith, H.E., Radcliff, K. et al. Odontoid Fractures With Neurologic Deficit Have Higher Mortality and Morbidity. Clin Orthop Relat Res 470, 1614–1620 (2012). https://doi.org/10.1007/s11999-011-1994-8

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  • DOI: https://doi.org/10.1007/s11999-011-1994-8

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