Introduction: Type II odontoid fractures are the single most frequent cervical spine fractures in the elderly. Advanced age, multiple comorbidities, osteopenia and lack of management guidelines are but some of the reasons for poor outcome in this group of patients. In this ambispective study we attempted to identify the predictors of death following type II odontoid fractures in patients older than 60 over a 10-year period.

Methods: Demographic, clinical, imaging, and follow-up data for 66 patients with symptomatic type II odontoid fractures who were managed in this level I trauma center were statistically analyzed.

Results: The mean age was 75.8, 38 (57.6%) patients were male, and 54 (82%) patients had falls. The mean injury severity score (ISS) was 28.3, Glasgow Coma Scale (GCS) score was 12.2, ASIA motor score (AMS) was 74.6 and co-morbidity was 1.9. Evidence of spinal cord injury (SCI) was seen in 34 (51.5%) patients with a mean intramedullary lesion length of 30.6 millimeters. The odontoid peg was not displaced (Type A fracture) in 42 (63.6%) patients and was displaced (Type B fracture) in 24 (36.4%) patients. Thirty-four (51.5%) patients died during acute care and follow-up. Univariate analysis of 10 variables indicated that mortality had a statistical relationship with the GCS score (p = 0.005), ISS (p = 0.005), SCI (p = 0.007), fracture type (p= 0.01), AMS (p = 0.01), C2 sagittal diameter (p = 0.03), and surgery (p = 0.03). Multivariate regression analysis indicated that the GCS score at admission (p = 0.001), fracture type (p = 0.002), age (p = 0. 037), and surgery (p = 0.024) had a significant relationship with mortality.

Conclusions: Low GCS score, age, a displaced dens and non-operative management were risk factors for mortality in type II odontoid fractures in the elderly.

Patient Care: This study will help spine surgeons identify the risk factors for mortality in elderly patients with type II odontoid fractures in order to determine which patients would benefit from surgical intervention.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the primary risk factors for mortality in type II odontoid fractures in the elderly. 2) Discuss the role of surgery in treating elderly patients with type II odontoid fractures.

References: Chapman J et al: The AOSpine North America Geriatric Odontoid Fracture Mortality Study: A Retrospective Review of Mortality Outcomes for Operative Versus Nonoperative Treatment of 322 Patients With Long-Term Follow-up. Spine 38(13):1098-1104, 2013 Fehlings MG et al: Predictors of treatment outcomes in geriatric patients with odontoid fractures: AOSpine North America Multi-Centre Prospective GOF Study. Spine 38(11):881-886, 2013 Schoenfeld et al: Type II Odontoid Fractures of the Cervical Spine: Do Treatment Type and Medical Comorbidities Affect Mortality in Elderly Patients? Spine 36(11):879-885, 2011 Smith JS et al: Effect of type II odontoid fracture nonunion on outcome among elderly patients treated without surgery: based on the AOSpine North America geriatric odontoid fracture study. Spine 38(26):2240-6, 2013