SCORE Study: Comparing Surgery and Rigid Collar Treatment for Odontoid Fractures in Adults Over 70
NCT ID: NCT06961578
Last Updated: 2025-05-08
Study Results
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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NOT_YET_RECRUITING
NA
322 participants
INTERVENTIONAL
2025-06-01
2028-06-01
Brief Summary
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* Does surgery or conservative collar treatment lead to better improvement in daily living, measured by the Barthel Index, after 12 weeks?
* What are the differences in pain, disability, and quality of life between the two treatments?
The study team will compare patients who receive surgical stabilization with those who are treated with a rigid cervical collar to see which approach supports better functional outcomes and healing.
Participants will:
* be randomly assigned to either surgery (posterior C1-C2 screw-rod fixation) or conservative collar treatment
* attend study visits at 12 weeks and 6 months
* complete questionnaires on daily functioning, pain, and quality of life
* undergo CT scans and other medical assessments
* record collar use (for conservative group) in a diary
* be monitored for any complications or changes in treatment (including crossover to surgery if needed)
The study aims to include 322 participants to provide evidence on which treatment helps older adults recover better from odontoid fractures with fewer complications and improved quality of life.
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Detailed Description
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Study Objectives A) Primary Objective: To compare the effectiveness of surgical versus conservative treatment for unstable OFs in patients aged 70 or older in terms of recovery in activities of daily living, measured by the change in Barthel Index (BI) from baseline to 12 weeks.
B) Secondary Objectives: To compare the effects of treatment on:
* Quality of life (EQ-5D)
* Neck pain (Visual Analog Scale)
* Neck-specific disability (Neck Disability Index)
* Radiographic fracture healing
* Treatment compliance
* Rate of crossover from conservative to surgical treatment
* Incidence of adverse and serious adverse events
This is a prospective, two-arm, multicenter, randomized controlled non-inferiority trial with parallel-group design. Patients will be randomized 1:1 to receive either surgical stabilization (posterior C1-C2 screw-rod fixation) or conservative treatment with a rigid cervical collar. Randomization will be stratified by center using permuted blocks via the secure online platform randomizer.at. Participants are followed up at 12 weeks and 6 months post-injury. An additional visit \~2 weeks after surgery is conducted for those undergoing surgical treatment. Patients in the conservative arm may cross over to surgery up to week 12, based on clinical indication or patient preference.
Intervention Descriptions A) Surgical Group: Posterior stabilization using a screw-rod system without additional external bracing. The surgery lasts \~100 minutes and requires \~6 days of hospital stay. This approach is tailored for geriatric patients and excludes anterior fixation due to biomechanical concerns in the elderly.
B) Conservative Group: External immobilization using a rigid cervical collar for 12 weeks. Compliance is monitored via patient diaries, acknowledging real-world challenges in consistent brace use. Lack of adherence is considered reflective of routine clinical practice.
Statistical Analyses The primary analysis will assess non-inferiority of conservative treatment versus surgery using a mixed model for repeated measures (MMRM) of the BI at 12 weeks. Covariates include treatment, time, interaction terms, baseline BI, age, and CCI; study center is treated as a random effect (excluded if convergence fails). Non-inferiority is defined by a margin of 5 BI points, which is more conservative than the minimal clinically important difference (MCID) of 9.8 and closer to the smallest detectable change (SDC) of 3.0, based on prior studies. The study has 90% power to detect non-inferiority (one-sided α = 0.025). A total of 137 patients per arm (274 total) are needed, inflated to 322 to account for 15% attrition.
Secondary analyses will use similar mixed models for continuous variables and generalized estimating equations for binary outcomes. Sensitivity analyses include "as-treated" models accounting for crossover. No adjustment for multiple comparisons will be made.
Randomization Procedure Randomization is conducted after informed consent via randomizer.at. Lists are stratified by center and use permuted blocks. Access is password-protected and managed by study personnel.
An independent Data and Safety Monitoring Board (DSMB) will oversee the study. All adverse events and serious adverse events are recorded at each visit and coded per MedDRA prior to analysis.
Conditions
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Study Design
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RANDOMIZED
PARALLEL
TREATMENT
NONE
Study Groups
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Conservative Group
conservative group subjected to external collar bracing
External immobilization with rigid cervical collar
External immobilization with a rigid cervical collar for 12 weeks. Compliance is monitored through patient diaries, recognizing the real-world challenges of consistent brace use. Lack of adherence is considered to reflect routine clinical practice. A typical drawback of the conservative intervention in daily practice is the absolute reliance on patient compliance to wear the collar continuously for at least 12 weeks, which poses a significant challenge to this treatment strategy.
Surgical Group
surgical group undergoing C1-2 instrumentation
C1-2 instrumentation
Surgical fracture stabilization with a posterior screw-rod system from C1-2 from a posterior approach.
The routine surgery commonly lasts approximately 100 minutes and requires a hospital stay of about 6 days. An additional external bracing in the postoperative setting is not required.
Interventions
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C1-2 instrumentation
Surgical fracture stabilization with a posterior screw-rod system from C1-2 from a posterior approach.
The routine surgery commonly lasts approximately 100 minutes and requires a hospital stay of about 6 days. An additional external bracing in the postoperative setting is not required.
External immobilization with rigid cervical collar
External immobilization with a rigid cervical collar for 12 weeks. Compliance is monitored through patient diaries, recognizing the real-world challenges of consistent brace use. Lack of adherence is considered to reflect routine clinical practice. A typical drawback of the conservative intervention in daily practice is the absolute reliance on patient compliance to wear the collar continuously for at least 12 weeks, which poses a significant challenge to this treatment strategy.
Other Intervention Names
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Eligibility Criteria
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Inclusion Criteria
* Acute unstable OFs (types II, III as classified by Anderson and d'Alonzo, and atypical)
* Less than two weeks post injury
* Written informed consent
Exclusion Criteria
* Concomitant fractures of the subaxial cervical spine necessitating surgery
* Significant comorbidity resulting in inoperability of the patient: i.e. ASA score \> 4
* Neurological compromise due to displaced fracture
70 Years
ALL
No
Sponsors
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St. Josefs-Hospital Wiesbaden GmbH
OTHER
Medical University of Cologne
OTHER
BG Trauma Center Tuebingen
OTHER
RWTH Aachen University
OTHER
University Hospital Heidelberg
OTHER
University Hospital, Essen
OTHER
BG Klinikum Bergmannstrost, Halle, Germany
UNKNOWN
Helios Klinikum Berlin-Buch
OTHER
German Federal Ministry of Education and Research
OTHER_GOV
Charite University, Berlin, Germany
OTHER
Technical University of Munich
OTHER
Responsible Party
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Locations
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LMU University Hospital
Munich, Bavaria, Germany
Center for Spinal Surgery and Neurotraumatology, Berufsgenossenschaftliche Unfallklinik
Frankfurt am Main, Hesse, Germany
Department of Neurosurgery, RWTH Aachen University
Aachen, , Germany
Charité University Hospital Berlin
Berlin, , Germany
Department of Neurosurgery and Spine Center, HELIOS Hospital Berlin Buch
Berlin, , Germany
Department of Orthopaedic and Traumatology, University of Cologne
Cologne, , Germany
Department of Orthopedics, Medical University at Dresden
Dresden, , Germany
Department of Neurosurgery and Spine Surgery, University Hospital Essen
Essen, , Germany
Department of Neurosurgery, University Medical Center Göttingen
Göttingen, , Germany
Department of Trauma and Reconstructive Surgery, BG Klinikum Bergmannstrost Halle
Halle, , Germany
Department of Neurosurgery, University Hospital Heidelberg
Heidelberg, , Germany
Department of Neurosurgery, University Hospital of Lausitz
Lausitz, , Germany
Department of Orthopaedics, Trauma Surgery and Plastic Surgery, University of Leipzig
Leipzig, , Germany
Spine Surgery, Orthopedic Hospital Markgröningen GmbH
Markgröningen, , Germany
BG Trauma Centre, Eberhard Karls University of Tuebingen
Tübingen, , Germany
Spine Center, St. Josefs-Hospital Wiesbaden
Wiesbaden, , Germany
Countries
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Central Contacts
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Facility Contacts
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Other Identifiers
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01KG2405
Identifier Type: OTHER_GRANT
Identifier Source: secondary_id
2024-630-S-NP
Identifier Type: -
Identifier Source: org_study_id
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