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Surgery for dens fractures shows significant functional, quality of life improvement
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Patients who underwent surgical treatment for type II dens fractures had significantly improved functional and quality of life results compared to patients who did not have surgery, according to this study.
“We recommend that elderly patients with a type-II dens fracture who are healthy enough for general anesthesia be considered for surgical stabilization to improve functional outcome as well as the union and fusion rates,” Alexander R. Vaccaro, MD, PhD, and colleagues wrote in the abstract.
Vaccaro and colleagues divided 159 patients with type II dens fractures into surgical and nonsurgical groups. Most patients (79%) who underwent surgery had a posterior C1-C2 arthrodesis, while most of the patients in the nonsurgical group (81%) wore a hard collar to immobilize the neck. After 12 months, the NDI score in the nonsurgical group decreased by 14.7 points, indicating a worse outcome. In comparison, the surgical group had a 5.7 point increase in the NDI, which was not statistically significant.
Additionally, SF-36 scores in the surgical group were significantly improved over the nonsurgical group, and there was a significantly lower rate of nonunion, according to the abstract. The overall mortality rate in the study was 18% across both groups, but mortality was higher in the nonsurgical group.
The authors noted that because of the nonrandomized nature of the study, there may “possible residual confounding” in the results.
Disclosure: The authors reported various financial disclosures. See the full study for a complete list of disclosures.
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