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Morbidity and Mortality of C2 Fractures in the Elderly: Surgery and Conservative Treatment

Chen, Yi-Ren BA, BS*,‡; Boakye, Maxwell MD*,§; Arrigo, Robert T. BS; Kalanithi, Paul S. A. MD; Cheng, Ivan MD; Alamin, Todd MD; Carragee, Eugene J. MD; Mindea, Stefan A. MD; Park, Jon MD, FRCS(C)

doi: 10.1227/NEU.0b013e3182446742
Research-Human-Clinical Studies
CNS University of Neurosurgery
Press Release

BACKGROUND: Closed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients.

OBJECTIVE: To compare outcomes for elderly patients with closed C2 fractures by treatment modality.

METHODS: We retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival.

RESULTS: Surgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups.

CONCLUSION: The 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

Stanford University School of Medicine, Stanford, California

§Center for Advanced Neurosurgery, University of Louisville, Louisville, Kentucky

Departments of Neurosurgery

Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California

Correspondence: Maxwell Boakye, MD FACS, Center for Advanced Neurosurgery, University of Louisville, 220 Abraham Flexner Way, 1105, Louisville, KY 40202. E-mail:

* Authors contributed equally to this article.

Received September 16, 2010

Accepted October 14, 2011

Copyright © by the Congress of Neurological Surgeons