Treatment of odontoid type II fractures in octogenarians: Balancing two different treatment strategies

Abstract

Objective: Demographic changes have led to a higher incidence of C-2 fractures, especially in elderly patients. For patients with type II fractures, treatment remains controversial, as discussed by Anderson and D’Alonzo, due to the rising morbidity and mortality rates for any treatment. The aim of this study was to compare conservative and surgical management in patients with type II C-2 fractures regarding outcomes, complications, and the mortality rate. Methods: A retrospective analysis was performed of the medical records, X-rays, and/or computed tomography scans of patients ≥ 80 years of age with type II fractures who were admitted to our Department of Neurosurgery between January 1990 and December 2017. The success of treatment was evaluated 3 months after surgery. Results: In total, 125 patients were included, of whom 98 were treated surgically and 27 were treated conservatively. Surgical treatment was successful in 90. 8% of cases, while conservative treatment was successful in 70. 0%. The in-hospital mortality was 14. 29% and the 3-month mortality was 27. 8% in the surgical group, compared to 3. 7% and 20% in the conservatively treated group. The in-hospital complication rate was 22. 4% in the surgically treated patients and 7. 4% in the conservatively treated patients. Conclusion: Surgical treatment of type II fractures seemed to be associated with higher success and complication rates than conservative treatment. Nevertheless, 3-month mortality was comparable in both groups. Therefore, we conclude that surgical treatment for type II fractures in elderly patients is superior to conservative management, although conservative treatment remains a valuable option in elderly patients with severe comorbidities.