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Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis

BACKGROUND: It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures. METHODS...

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Autores principales: Fan, Lei, Ou, Dingqiang, Huang, Xuna, Pang, Mao, Chen, Xiu-Xing, Yang, Bu, Wang, Qi-You
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946417/
https://www.ncbi.nlm.nih.gov/pubmed/31689741
http://dx.doi.org/10.1097/MD.0000000000010281
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author Fan, Lei
Ou, Dingqiang
Huang, Xuna
Pang, Mao
Chen, Xiu-Xing
Yang, Bu
Wang, Qi-You
author_facet Fan, Lei
Ou, Dingqiang
Huang, Xuna
Pang, Mao
Chen, Xiu-Xing
Yang, Bu
Wang, Qi-You
author_sort Fan, Lei
collection PubMed
description BACKGROUND: It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures. METHODS: A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle–Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot. RESULTS: Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18–0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34–0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19–9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78–1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73–7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot. CONCLUSION: Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment.
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spelling pubmed-69464172020-01-31 Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis Fan, Lei Ou, Dingqiang Huang, Xuna Pang, Mao Chen, Xiu-Xing Yang, Bu Wang, Qi-You Medicine (Baltimore) 7100 BACKGROUND: It is unclear whether surgery or conservative treatment is more suitable for elderly patients with type II and type III odontoid fractures. We performed this meta-analysis to compare the efficacy of surgical and conservative treatments for type II and type III odontoid fractures. METHODS: A literature search was performed in PubMed, Embase, Web of Science, and Cochrane Library in January 2017. Only articles comparing surgery with conservative treatment in elderly patients with type II and type III odontoid fractures were selected. After 2 authors independently assessed the retrieved studies, 18 articles were included in this meta-analysis, and the primary endpoints were the nonunion rate and mortality rate. The secondary outcomes were patient satisfaction, complications, and the length of the hospital stay. The quality of the included studies was evaluated using the modified Newcastle–Ottawa scale. Sensitivity analyses were performed for high-quality studies, and the publication bias was evaluated using a funnel plot. RESULTS: Lower nonunion (odds ratio [OR]: 0.27, 95% confidence interval [CI]: 0.18–0.40, P < .05) and mortality rates (OR: 0.52, 95% CI: 0.34–0.79, P < .05) confirmed the superiority of surgery in treating type II and type III fractures. The secondary outcomes differed. Patients in the surgery group felt more satisfied with the outcome (OR: 3.44, 95% CI: 1.19–9.95, P < .05), and the complications were similar in the 2 groups (OR: 1.14, 95% CI: 0.78–1.68, P = .5), whereas patients in conservative groups spent less time in the hospital (OR: 5.10, 95% CI: 2.73–7.47, P < .05). The results of the subgroup analyses and sensitivity analysis were similar to the original outcomes, and no obvious publication bias was observed in the funnel plot. CONCLUSION: Most elderly (younger than 70 years) patients with type II or type III odontoid fractures should be considered candidates for surgical treatment, due to the higher union rate and lower mortality rate, while statistically significant differences were not observed in the population with an advanced age (older than 70 years). Therefore, the selection of the therapeutic approach for elderly patients with odontoid fractures requires further exploration. Simultaneously, based on our meta-analysis, a posterior arthrodesis treatment was significantly superior to the anterior odontoid screw treatment. Wolters Kluwer Health 2019-11-01 /pmc/articles/PMC6946417/ /pubmed/31689741 http://dx.doi.org/10.1097/MD.0000000000010281 Text en Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-Non Derivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0
spellingShingle 7100
Fan, Lei
Ou, Dingqiang
Huang, Xuna
Pang, Mao
Chen, Xiu-Xing
Yang, Bu
Wang, Qi-You
Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis
title Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis
title_full Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis
title_fullStr Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis
title_full_unstemmed Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis
title_short Surgery vs conservative treatment for type II and III odontoid fractures in a geriatric population: A meta-analysis
title_sort surgery vs conservative treatment for type ii and iii odontoid fractures in a geriatric population: a meta-analysis
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946417/
https://www.ncbi.nlm.nih.gov/pubmed/31689741
http://dx.doi.org/10.1097/MD.0000000000010281
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