FUNCTIONAL OUTCOME OF SURGICALLY AND CONSERVATIVELY MANAGED DENS FRACTURES

Study Design. Fifty-seven patients with dens fractures were identified from 1986 to 1996 at the authors' institution. Forty-six were availab le for reevaluation by two independent observers with a mean follow-up period of 26 months. Objective. To determine by age and fracture type which treatment regimen provided the best functional outcome in patie nts with dens fractures. Summary of Background Data. There were no Typ e I fractures, but there were 37 Type II and 20 Type ill fractures. Tw enty-nine patients were under 60 years of age, and 28 were 60 years an d older. Six patients had been treated by immediate C1-C2 posterior fu sion, and five received treatment with a Philadelphia collar only. For ty-six patients were placed in a halo thoracic immobilizer with a sym ptomatic nonunion rate of 19.5%. These patients ultimately required po sterior cervical fusion. Methods. Final functional outcome, level of p ain, and cervical range of motion were all statistically evaluated usi ng multivariate analysis (Wilcoxon's two-sample test). The influence o f age, fracture type, and treatment method were determined. Results. T here were no cases of short- or long-term neurologic deterioration in any of the patients in the study group. There was a significantly high er rate of complications associated with halo use in the older populat ion. Pain scores were higher in Type II fractures and in patients trea ted conservatively with halo immobilization, especially those patients over 60 years of age. No statistically significant difference in thes e parameters were found. Older patients treated surgically did not hav e a better functional outcome score than those treated nonoperatively (P < 0.8). Persons over 60 years of age treated in a halo had a signif icantly (P < 0.05) decreased range of motion when compared with younge r patients treated similarly. Conclusion. Patients over 60 years of ag e with a dens fracture had a higher complication rate and lower cervic al range of motion when treated conservatively with a halo. Final func tional outcome and overall pain levels, however, did not differ signif icantly by age group or treatment modality.