Treatment of Type II Odontoid Fractures Among the Elderly

NCT ID: NCT00266929

Last Updated: 2017-08-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

159 participants

Study Classification

OBSERVATIONAL

Study Start Date

2005-12-31

Study Completion Date

2010-05-31

Brief Summary

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The purpose of this study is to compare the safety and effectiveness of surgical versus conservative management of type II odontoid fractures among patients \> 64 years of age. Of secondary interest is to determine if there are differences in outcomes between anterior screw fixation and posterior fusion of these fractures.

Detailed Description

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Hypotheses are as follows:

* Patients receiving surgical management will exhibit better disease specific health and general health related quality of life measures compared to those managed conservatively.
* The rate of radiographic bony fusion will be greater among elderly patients receiving surgical fixation compared to patients receiving conservative management.
* The rate of non union will be greater in the conservative group compared to the surgical group.
* The complication rate will be higher in the surgical group due to the nature of the intervention though the rate of severe and serious complications will be low.

Conditions

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Neck Injuries Spinal Injuries

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Surgical

Subjects receiving surgical treatment for Type II odontoid fracture per discretion of investigator (non-randomized allocation)

surgical

Intervention Type PROCEDURE

surgical treatment of odontoid fractures

Non-surgical

Subjects treated with non-operative treatment options

conservative treatment

Intervention Type PROCEDURE

conservative stabilization of fractures

Interventions

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surgical

surgical treatment of odontoid fractures

Intervention Type PROCEDURE

conservative treatment

conservative stabilization of fractures

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* All new type II odontoid fractures including those in which the fracture line crosses into the body of C2
* Age \> 64
* Stable and unstable fractures
* \< 3 months post-injury
* No previous treatment for an odontoid fracture

Exclusion Criteria

* Pathological fractures unrelated to osteoporosis
* Severe dementia or severe mental health problems
* Participation in other trials or unlikely to attend follow-ups
Minimum Eligible Age

64 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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AOSpine North America

INDUSTRY

Sponsor Role collaborator

AOSpine North America Research Network

NETWORK

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Alexander R Vaccaro, MD

Role: PRINCIPAL_INVESTIGATOR

Thomas Jefferson University and The Rothman Institute

Locations

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Emory University SOM: Orthopedics

Atlanta, Georgia, United States

Site Status

Indiana Spine Group

Indianapolis, Indiana, United States

Site Status

Kansas University Medical Center

Kansas City, Kansas, United States

Site Status

John Hopkins University

Baltimore, Maryland, United States

Site Status

Brigham and Women's Hospital

Boston, Massachusetts, United States

Site Status

Mayo Clinic

Rochester, Minnesota, United States

Site Status

Cornell Weill Medical College

New York, New York, United States

Site Status

Cleveland Clinic

Cleveland, Ohio, United States

Site Status

Spinal Cord Injury Center Thomas Jefferson University and The Rothman Institute

Philadelphia, Pennsylvania, United States

Site Status

Vanderbilt University

Nashville, Tennessee, United States

Site Status

University of Utah

Salt Lake City, Utah, United States

Site Status

University of Virginia

Charlottesville, Virginia, United States

Site Status

Harborview Medical Center

Seattle, Washington, United States

Site Status

West Virginia University

Morgantown, West Virginia, United States

Site Status

Toronto Western Hospital

Toronto, Ontario, Canada

Site Status

Countries

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United States Canada

References

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Smith HE, Kerr SM, Maltenfort M, Chaudhry S, Norton R, Albert TJ, Harrop J, Hilibrand AS, Anderson DG, Kopjar B, Brodke DS, Wang JC, Fehlings MG, Chapman JR, Patel A, Arnold PM, Vaccaro AR. Early complications of surgical versus conservative treatment of isolated type II odontoid fractures in octogenarians: a retrospective cohort study. J Spinal Disord Tech. 2008 Dec;21(8):535-9. doi: 10.1097/BSD.0b013e318163570b.

Reference Type BACKGROUND
PMID: 19057244 (View on PubMed)

Smith HE, Vaccaro AR, Maltenfort M, Albert TJ, Hilibrand AS, Anderson DG, Harrop J, Fehlings MG, Kopjar B, Brodke DS, Arnold PM, Shaffrey CI. Trends in surgical management for type II odontoid fracture: 20 years of experience at a regional spinal cord injury center. Orthopedics. 2008 Jul;31(7):650.

Reference Type BACKGROUND
PMID: 19292388 (View on PubMed)

Vaccaro AR, Kepler CK, Kopjar B, Chapman J, Shaffrey C, Arnold P, Gokaslan Z, Brodke D, France J, Dekutoski M, Sasso R, Yoon ST, Bono C, Harrop J, Fehlings MG. Functional and quality-of-life outcomes in geriatric patients with type-II dens fracture. J Bone Joint Surg Am. 2013 Apr 17;95(8):729-35. doi: 10.2106/JBJS.K.01636.

Reference Type RESULT
PMID: 23595072 (View on PubMed)

Fehlings MG, Arun R, Vaccaro AR, Arnold PM, Chapman JR, Kopjar B. Predictors of treatment outcomes in geriatric patients with odontoid fractures: AOSpine North America multi-centre prospective GOF study. Spine (Phila Pa 1976). 2013 May 15;38(11):881-6. doi: 10.1097/BRS.0b013e31828314ee.

Reference Type RESULT
PMID: 23459135 (View on PubMed)

Chapman J, Smith JS, Kopjar B, Vaccaro AR, Arnold P, Shaffrey CI, Fehlings MG. The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976). 2013 Jun 1;38(13):1098-104. doi: 10.1097/BRS.0b013e318286f0cf.

Reference Type RESULT
PMID: 23354104 (View on PubMed)

Smith HE, Kerr SM, Fehlings MG, Chapman J, Maltenfort M, Zavlasky J, Harris E, Albert TJ, Harrop J, Hilibrand AS, Anderson DG, Vaccaro AR. Trends in epidemiology and management of type II odontoid fractures: 20-year experience at a model system spine injury tertiary referral center. J Spinal Disord Tech. 2010 Dec;23(8):501-5. doi: 10.1097/BSD.0b013e3181cc43c7.

Reference Type RESULT
PMID: 20940632 (View on PubMed)

Smith JS, Kepler CK, Kopjar B, Harrop JS, Arnold P, Chapman JR, Fehlings MG, Vaccaro AR, Shaffrey CI. Effect of type II odontoid fracture nonunion on outcome among elderly patients treated without surgery: based on the AOSpine North America geriatric odontoid fracture study. Spine (Phila Pa 1976). 2013 Dec 15;38(26):2240-6. doi: 10.1097/BRS.0000000000000009.

Reference Type RESULT
PMID: 24335630 (View on PubMed)

Other Identifiers

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07-GOF-05

Identifier Type: -

Identifier Source: org_study_id

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