{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T03:09:10Z","timestamp":1784776150605,"version":"3.55.0"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T00:00:00Z","timestamp":1724803200000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"EUROSPINE Start-up Grant"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The optimal treatment for odontoid fractures in older people remains debated. Odontoid fractures are increasingly relevant to clinical practice due to ageing of the population.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>An international prospective comparative study was conducted in fifteen European centres, involving patients aged \u226555\u00a0years with type II\/III odontoid fractures. The surgeon and patient jointly decided on the applied treatment. Surgical and conservative treatments were compared. Primary outcomes were Neck Disability Index (NDI) improvement, fracture union and stability at 52\u00a0weeks. Secondary outcomes were Visual Analogue Scale neck pain, Likert patient-perceived recovery and EuroQol-5D-3L at 52\u00a0weeks. Subgroup analyses considered age, type II and displaced fractures. Multivariable regression analyses adjusted for age, gender and fracture characteristics.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study included 276 patients, of which 144 (52%) were treated surgically and 132 (48%) conservatively (mean (SD) age 77.3 (9.1) vs. 76.6 (9.7), P\u2009=\u20090.56). NDI improvement was largely similar between surgical and conservative treatments (mean (SE) \u221211 (2.4) vs. \u221214 (1.8), P\u2009=\u20090.08), as were union (86% vs. 78%, aOR 2.3, 95% CI 0.97\u20135.7) and stability (99% vs. 98%, aOR NA). NDI improvement did not differ between patients with union and persistent non-union (mean (SE) \u221213 (2.0) vs. \u221212 (2.8), P\u2009=\u20090.78). There was no difference for any of the secondary outcomes or subgroups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Clinical outcome and fracture healing at 52\u00a0weeks were similar between treatments. Clinical outcome and fracture union were not associated. Treatments should prioritize favourable clinical over radiological outcomes.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ageing\/afae189","type":"journal-article","created":{"date-parts":[[2024,8,28]],"date-time":"2024-08-28T13:59:53Z","timestamp":1724853593000},"source":"Crossref","is-referenced-by-count":18,"title":["Surgical versus conservative treatment for odontoid fractures in older people: an international prospective comparative study"],"prefix":"10.1093","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9095-3814","authenticated-orcid":false,"given":"Jeroen G J","family":"Huybregts","sequence":"first","affiliation":[{"name":"Department of Neurosurgery , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Leiden University Medical Centre , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Department of Neurosurgery, University Neurosurgical Centre Holland, Haaglanden Medical Centre , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel B","family":"Polak","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Leiden University Medical Centre , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Department of Neurosurgery, University Neurosurgical Centre Holland, Haaglanden Medical Centre , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco C","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Department of Neurosurgical Research, The Health Scientist , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark P","family":"Arts","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Neurosurgical Centre Holland, Haaglanden Medical Centre , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , School of Medicine, , Munchen , Germany"},{"name":"Technical University Munich , School of Medicine, , Munchen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Wostrack","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , School of Medicine, , Munchen , Germany"},{"name":"Technical University Munich , School of Medicine, , Munchen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vicki M","family":"Butensch\u00f6n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , School of Medicine, , Munchen , Germany"},{"name":"Technical University Munich , School of Medicine, , Munchen , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Osti","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery and Sports Traumatology, Academic Hospital Feldkirch , Feldkirch , Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F Cumhur","family":"\u00d6ner","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics\/Neurosurgery, University Medical Centre Utrecht , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem-Bart M","family":"Slooff","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedics\/Neurosurgery, University Medical Centre Utrecht , Utrecht , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo E","family":"Feller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Amsterdam University Medical Centre , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gert-Joan","family":"Bouma","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Amsterdam University Medical Centre , Amsterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biswadjiet S","family":"Harhangi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Erasmus Medical Centre Rotterdam , Rotterdam , The Netherlands"},{"name":"Department of Neurosurgery, Park Medical Centre Rotterdam , Rotterdam , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bart","family":"Depreitere","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospitals Leuven , Leuven , Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein P","family":"Nygaard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, St Olavs University Hospital , Trondheim , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clemens","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Stavanger University Hospital , Stavanger , Norway"},{"name":"Department of Quality and Health Technology, University of Stavanger , Stavanger , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kay","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital North Norway , Troms\u00f8 , Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Timothy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Leeds , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferran","family":"Pellis\u00e9","sequence":"additional","affiliation":[{"name":"Spine Unit, Vall d\u2019Hebron University Hospital , Barcelona , Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikkel M","family":"Rasmussen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Aarhus University Hospital , Aarhus , Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik W","family":"van Zwet","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Centre , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ewout W","family":"Steyerberg","sequence":"additional","affiliation":[{"name":"Department of Biomedical Data Sciences, Leiden University Medical Centre , Leiden , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilco C","family":"Peul","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Leiden University Medical Centre , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Department of Neurosurgery, University Neurosurgical Centre Holland, Haaglanden Medical Centre , The Hague , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen L A","family":"Vleggeert-Lankamp","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Leiden University Medical Centre , University Neurosurgical Centre Holland, , Leiden , The Netherlands"},{"name":"Department of Neurosurgery, Spaarne Gasthuis Hoofddorp , Hoofddorp , The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,28]]},"reference":[{"key":"2024082808230671100_ref1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.spinee.2004.09.014","article-title":"Proposal of a modified, treatment-oriented classification of odontoid 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