Tag: Conservative

Posted on

Comparative Effectiveness of Conservative Management Versus Surgical Fixation in Acute Type II Odontoid Fractures

Neurosurgery 98:61–72, 2026

This retrospective single-center study compares radiological and functional outcomes of conservative versus surgical management for acute type II odontoid fractures in an elderly cohort treated from 2015–2023. Results show surgical fixation markedly increases radiographic union rates, while conservative bracing predominated and delivered superior early pain control with similar long-term functional independence.

Multivariable modeling identified surgery as the strongest positive predictor of union, whereas age ≥80, smoking, osteoporosis, higher frailty, and angulation ≥11° reduced union odds and lowered likelihood of surgical selection. Complication rates and hospital stays were higher after surgery, supporting individualized treatment decisions balancing union probability, pain, frailty, and perioperative risk.

Surgical fixation increases the odds of fracture union in acute type II odontoid fractures (adjusted OR = 6.6), but does not improve long-term functional independence or survival compared to conservative management.

Conservative management (mainly rigid collars) is preferred for elderly or frail patients and achieves similar functional outcomes (modified Rankin Scale ≤2: 75% vs 73%) and better early pain control (75% vs 47%) than surgery, despite lower union rates.

Fracture union rates are significantly higher after surgery (44% vs 10% with conservative treatment, P < .01), but most conservatively managed patients achieve stable nonunion without adverse functional impact.

Advanced age (≥80 years), frailty, smoking, osteoporosis, and fracture angulation ≥11° are all strong negative predictors of fracture union, regardless of treatment approach.

Surgical patients are typically younger, less frail, and have greater fracture displacement or posterior displacement, reflecting selection bias in surgical decision-making.

Complication rates are higher with surgery (40% vs 2% for conservative), and surgical patients have longer hospital stays (median 11 vs 3 days), but most complications do not require reoperation.

Mortality rates at five years are similar between conservative and surgical groups (52% vs 53%), indicating no survival advantage with operative intervention.

Conservative treatment is a safe, effective option for most elderly or frail patients with type II odontoid fractures, reserving surgery for younger, medically fit individuals or those with unstable fracture patterns

Posted on

Long-term Outcomes of Patients With Giant Intracranial Arteriovenous Malformations

giant AVM

Neurosurgery 79:116–124, 2016

Giant intracranial arteriovenous malformations (AVMs) are rare cerebrovascular lesions that pose management challenges.

OBJECTIVE: To further clarify outcomes in patients with giant cerebral AVMs managed with conservative or interventional therapies.

METHODS: We performed a retrospective review of all patients diagnosed with AVMs evaluated at our institution from 1990 to 2013. Patients with a single intracranial AVM .6 cm were included. Patients were divided into 2 groups: conservative management or intervention (microsurgery, radiosurgery, or embolization). Functional outcome was assessed with the modified Rankin Scale (mRS) and compared between the 2 groups.

RESULTS: A total of 55 patients with giant AVMs were included, and 35 patients (63.6%) had clinical follow-up with a mean of 11.8 years. Spetzler-Martin grades were as follows: grade III, n = 2 (3.6%); grade IV, n = 15 (27.3%); and grade V, n = 38 (69.1%). Twenty-four patients (43.6%) were conservatively managed. The patients in the conservatively managed group had larger AVMs (P , .05) with more frequent involvement of the temporal lobe (P = .02). Five patients (26.3%) in the conservatively managed group and 5 (31.3%) in the intervention group experienced hemorrhage during follow-up, translating to an annualized risk of 2.7% and 4.1%, respectively. No significant difference in risk of first subsequent hemorrhage was observed (P = .78). Despite comparable mRS scores at presentation, we observed a trend toward better outcomes (mRS , 2) in patients undergoing conservative management (P = .06) compared with the intervention group at last follow-up.

CONCLUSION: This study suggests that interventions for giant AVMs should be considered cautiously because hemorrhagic risk is similar regardless of management strategy and functional outcome is likely to be same or better in the conservatively managed population.

Proudly powered by WordPress