Surgical Intervention Versus Cervical Collar Treatment of Displaced Type II Odontoid Fractures in the Elderly: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES: The treatment of displaced odontoid type II fractures in the elderly is controversial. The objective of this study was to compare surgical intervention with cervical collar treatment. METHODS: This open-label, randomized controlled superiority trial included neurologically intact participants 75 years and older with displaced odontoid type II fractures, randomized to posterior C1-C2 surgery or cervical collar treatment. The primary outcome was Neck Disability Index (NDI) at the 1 year follow-up. Secondary outcomes included the EuroQol 5 Dimensions (EQ-5D) index, EuroQol-visual analogue scale, radiological data and mortality. Between-group comparisons used the Mann-Whitney U test; within-group comparisons used the Wilcoxon signed-rank test. Multiple imputation was used to account for missing data in NDI and EQ-5D index. RESULTS: Forty-seven participants (25 surgical group, 22 cervical collar group) were randomized. Median [IQR] baseline NDI was 40% [18%-60%] in the surgical group and 44% [27%-65%] in the cervical collar group. At 1 year, NDI was 24% [5%-33%] in the surgical group and 34% [8%-50%] in the cervical collar group (P = .29 for group comparison, and P = .028 and P = .16 for within group change, respectively). Median EQ-5D index at 1 year was 0.71 [0.39-0.94] and 0.62 [0.195-1], and EuroQol-visual analogue scale was 70 [45-77.5] and 60 [37.5-75]. Bony union and radiological stability were more frequent in the surgical group. One year mortality was 7 and 3 participants, respectively (P = .3). CONCLUSION: Surgical intervention was not superior to treatment with a cervical collar for displaced type II odontoid fractures.