Dr ALLIA Jeremy

Early mortality and morbidity of odontoid fractures after 70 years of age

Jeremy Allia, Hugo Darmanté, Laurent Barresi, Fernand De Peretti, Christophe Trojani, Nicolas Bronsard

https://pubmed.ncbi.nlm.nih.gov/32094064/

Abstract

Introduction: Odontoid fractures are very common in older adults and are associated with a high mortality rate. The aim of this study was to evaluate the outcomes after conservative treatment of non-displaced odontoid fractures and surgical treatment of displaced fractures in patients older than 70 years. It was hypothesized that early mortality of displaced fractures is higher than in non-displaced fractures.

Material and methods: This was a single-center retrospective observational study of odontoid fractures (type II in the Anderson and Alonzo classification) in patients older than 70 years that occurred between 2014 and 2017. Conservative treatment with immobilization for 3 months was proposed when the fracture was displaced less than 2 mm (non-displaced fracture group). Surgical treatment in the form of anterior screw fixation was proposed when the fracture displacement was more than 2 mm (displaced fracture group). The primary endpoint was the mortality rate at 3 months.

Results: The study included 79 patients (46 women) who had a mean age of 85 years (70-105). The 3-month mortality in the entire cohort was 27% and the 1-year mortality was 30%. Conservative treatment was provided to the 36 patients with non-displaced fractures. The 3-month mortality rate in this group was 11%. A displaced fracture occurred in 43 patients: 17 were treated surgically by anterior screw fixation; 20 could not be operated on because of anesthesia contraindications and 6 died within 24hours of the fracture event. The 3-month mortality rate in this group was 40%; 3 of the 17 operated patients died from postoperative respiratory complications; 8 of the 20 patients with contraindications died, in addition to the 6 that died soon after the fracture occurred.

Discussion: This study confirms that mortality and morbidity are high following odontoid fractures. The mortality rate was significantly higher in patients with displaced fractures, confirming our hypothesis. The mortality rate was especially high when patients with displaced fractures could not undergo surgery because of anesthesia contraindications. Also, there was a high rate of respiratory complications after anterior screw fixation of displaced fractures.

Conclusion: Given our findings, conservative treatment should be compared to surgical treatment for displaced fractures and the anterior approach should be compared to the posterior one for surgical cases.

Level of evidence: IV.

Keywords: Anterior Screw Fixation; Conservative treatment; Elderly; Mortality; Odontoid Fracture.

Copyright © 2020 Elsevier Masson SAS. All rights reserved.

Mortality, complication, and fusion rates of patients with odontoid fracture: the impact of age and comorbidities in 204 cases

Yann Philippe Charles, Yves Ntilikina, Benjamin Blondel, Stéphane Fuentes, Jérémy Allia, Nicolas Bronsard, Maxime Lleu, Benjamin Nicot, Vincent Challier, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Julien Berthiller, Eurico Freitas, Cédric Barrey

https://pubmed.ncbi.nlm.nih.gov/30317379/

Abstract

Purpose: The French Society of Spine Surgery (SFCR) conducted a prospective epidemiologic multicenter study. The purpose was to investigate mortality, complication, and fusion rates in patients with odontoid fracture, depending on age, comorbidities, fracture type, and treatment.

Methods: Out of 204 patients, 60 were ≤ 70 years and 144 were > 70 years. Demographic data, comorbidities, treatment types and complications (general medical, infectious, neurologic, and mechanical), and death were registered within the first year. Fractures were classified according to Anderson-D’Alonzo and Roy-Camille on the initial CT. A 1-year follow-up CT was available in 144 patients to evaluate fracture consolidation.

Results: Type II and oblique-posterior fractures were the most frequent patterns. The treatment was conservative in 52.5% and surgical in 47.5%. The mortality rate in patients ≤ 70 was 3.3% and 16.7% in patients > 70 years (p = 0.0002). Fracture pattern and treatment type did not influence mortality. General medical complications were significantly more frequent > 70 years (p = 0.021) and after surgical treatment (p = 0.028). Neurologic complications occurred in 0.5%, postoperative infections in 2.0%, and implant-related mechanical complications in 10.3% (associated with pseudarthrosis). Fracture fusion was observed in 93.5% of patients ≤ 70 years and in 62.5% >70 years (p < 0.0001). Pseudarthrosis was present in 31.5% of oblique-posterior fractures and in 24.3% after conservative treatment.

Conclusions: Age and comorbidities influenced mortality and medical complication rates most regardless of fracture type and treatment choice. Pseudarthrosis represented the main complication, which increased with age. Pseudarthrosis was most frequent in type II and oblique-posterior fractures after conservative treatment.

Keywords: Epidemiology; Fusion; Morbidity; Mortality; Odontoid fracture.

Hangman’s fracture: Management strategy and healing rate in a prospective multi-centre observational study of 34 patients

Solène Prost, Cédric Barrey, Benjamin Blondel, Stéphane Fuentes, Laurent Barresi, Benjamin Nicot, Vincent Challier, Maxime Lleu, Joël Godard, Pascal Kouyoumdjian, Nicolas Lonjon, Paulo Marinho, Eurico Freitas, Sébastien Schuller, Jérémy Allia, Julien Berthiller, Yann Philippe Charles; French Society for Spine Surgery (SFCR)

https://pubmed.ncbi.nlm.nih.gov/31005699/

Abstract

Background: Hangman’s fractures account for 15% to 20% of all cervical spine fractures. The grading system developed by Effendi and modified by Levine and Edwards is generally used as the basis for management decisions. Nonetheless, the optimal management remains controversial. The objective of this study was to describe the treatments used in France in patients with hangman’s fractures. The complications and healing rates were analysed according to the fracture type and treatment used.

Hypothesis: Among patients with hangman’s fracture, those with disc damage must be treated surgically.

Material and methods: A prospective, multi-centre, observational study was conducted under the aegis of the French Society for Spine Surgery (SociétéFrançaisedeChirurgieRachidienne, SFCR). Patients were included if they had computed tomography (CT) evidence of hangman’s fracture. Follow-up data were collected prospectively. Fracture healing was assessed on CT scans obtained 3 and 12 months after the injury. The type of treatment and complications were recorded routinely.

Results: We included 34 patients. The fracture type according to Effendi modified by Levine and Edwards was I in 68% of patients, II in 29% of patients, and III in a single patient (3%). The treatment was non-operative in 21 (62%) patients and surgical in 11 (32%). All 28 patients re-evaluated after 1 year had evidence of fracture healing. The remaining 6 patients were lost to follow-up.

Conclusion: Hangman’s fracture is associated with low rates of mortality and neurological complications. Non-operative treatment is appropriate in Type I hangman’s fracture, with a 100% healing rate in our study. Types II and III are characterised by damage to the ligaments and discs requiring either anterior C2-C3 fusion or posterior C1-C3 screw fixation.

Level of evidence: III.

Keywords: Bone healing; Cervical spine; Fracture union; Hangman’s fracture; Surgery.

Copyright © 2019 Elsevier Masson SAS. All rights reserved.

Influence of Derotation Connectors on 3D Surgical Correction of Adolescent Idiopathic Scoliosis

Jérémy Allia, Jean-Luc Clément, Virginie Rampal, Béatrice Leloutre, Olivier Rosello, Federico Solla

https://pubmed.ncbi.nlm.nih.gov/29494458/

Abstract

Study design: Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery.

Objective: The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery.

Summary of background data: Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis.

Methods: Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D-, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation.

Results: The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D- group, mean axial torsion increase of 4% (-0.42 degrees, 95% confidence interval, -1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D- group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05).

Conclusions: The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.