New Findings in Clinical Trials and Studies Described from Western General Hospital (Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review)

By a News Reporter-Staff News Editor at Clinical Trials Week -- Researchers detail new data in Clinical Research - Clinical Trials and Studies. According to news reporting from Edinburgh, United Kingdom, by NewsRx journalists, research stated, "Odontoid process fractures, of which type U constitute the majority, are an increasingly important cause of morbidity and mortality in the elderly population. The incidence of geriatric type II fractures is steadily increasing in line with the aging population."

The news correspondents obtained a quote from the research from Western General Hospital, "However, the decision between surgical and non-surgical intervention for type II fractures in the elderly remains controversial. The present study aims to synthesize the current published literature comparing out-comes following surgical and non-surgical interventions for type II odontoid fractures in the elderly population (>= 65 years old). Systematic review and meta-analysis were performed. A systematic search of MEDLINE, IN/IEDLINE In-Progress & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) was performed to identify available evidence in English language. Studies with extractable data for all type II odontoid fractures in participants aged 65 years or older and which compared surgical and non -surgical intervention were included. Methodological quality was assessed using the Downs & Black checklist. Primary outcomes were mortality at short-term follow-up (<= 3 months), mortality at long-term follow-up (predetermined study endpoint or mean follow-up length), and radiological union rate. Funding was provided by The University of Edinburgh for travel expenses to present this paper at the Society of British Neurological Sciences 2016 Conference ($170). Twelve studies (n=1,098), all non-randomized, met eligibility criteria. Methodological quality was particularly poor in the confounding, bias, and power domains of assessment. Substantial methodological and statistical heterogeneity allowed only a narrative synthesis of the primary outcomes. Overall, data on mortality at short-term follow-up appeared to favor neither surgical nor non -surgical intervention. A small favorable outcome in surgically managed patients over non surgically managed patients in terms of mortality at long-term follow-up was not proven conclusive because of considerable heterogeneity in study methodologies. Inadequate reporting of the time point of union assessment introduced the potential for significant -and interstudy heterogeneity and precluded assessment of union rates. Evidence on this controversial topic is sparse, markedly heterogeneous, and of poor quality. Well-designed prospective trials adhering to guidance published by the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative are required to inform clinical practice on this contentious but growing issue."

According to the news reporters, the research concluded: "Future randomized controlled trials should include an assessment of frailty and medical comorhidities with suitable patients subsequently randomized to surgical or non-surgical treatment."

For more information on this research see: Surgical versus nonsurgical management for type II odontoid fractures in the elderly population: a systematic review. Spine Journal, 2018;18(10):1921-1933. Spine Journal can be contacted at: Elsevier Science Inc, 360 Park Ave South, New York, NY 10010-1710, USA. (Elsevier - www.elsevier.com; Spine Journal - www.journals.elsevier.com/spine-journal/)

Our news journalists report that additional information may be obtained by contacting A.K. Demetriades, Western Gen Hosp, Dept. of Clin Neurosci, Edinburgh Spinal Surg Outcomes Study Grp, Edinburgh EH4 2XU, Midlothian, United Kingdom (see also Clinical Research - Clinical Trials and Studies).

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