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Surgical Treatment of C2 Fractures in the Elderly: A Multicenter Retrospective Analysis

Omeis, Ibrahim MD*; Duggal, Neil MD; Rubano, Jerry BS*; Cerabona, Franco MD; Abrahams, John MD*; Fink, Marie BS; Das, Kaushik MD*

doi: 10.1097/BSD.0b013e3181723d1b
Original Articles

Study Design Multicenter retrospective analysis.

Objectives To review the results of surgical treatment during the last 6 years of C2 fractures in patients over the age of 70.

Summary of Background Data Little information exists about the clinical outcome of surgical treatment of elderly patients with C2 fractures, their ability to return to their previous environment, and their postoperative level of independence.

Methods The medical records and radiographs of 29 patients who had undergone surgical treatment for C2 fractures were reviewed. The type of C2 fracture, neurologic examination at presentation, type of surgical treatment, perioperative morbidity and mortality, presence of osseous union, and stability of alignment were recorded. Long-term disposition was determined from office visits or by telephone interview.

Results Twenty-four of 29 patients had type II dens fractures alone. The remaining 5 had associated C1 fractures. All patients were neurologically intact at presentation except for 2 patients with signs and symptoms of central cord syndrome. Perioperative complications occurred in 3 patients (10.3%). One patient died on postoperative day 6 from a myocardial infarction. Mean±SD radiographic follow-up was 9±3.2 months (range, 3 to 24). Of the 16 patients who underwent odontoid screw fixation, 6 (37.5%) had osseous union, and 9 (56.2%) were stable on radiographs. An additional patient who had odontoid screw initially required a posterior approach reoperation. Of the 13 posterior fusions, 4 (30.7%) had osseous unions and 9 (69.2%) were stable on flexion extension radiographs. Mean±SD clinical follow-up was 18±2.2 months (range, 3 to 72 mo). Twenty-five of 29 patients (86.2%) returned to their previous environment. Two patients died of unrelated etiology.

Conclusions C2 fractures in the elderly can be treated surgically with both anterior and posterior approaches with acceptable morbidity and mortality rates. The majority of patients can be mobilized early and return to their previous levels of independence.

Departments of *Neurosurgery

Orthopedics, New York Medical College, Valhalla and New York, NY

Department of Clinical Neurological Sciences (Neurosurgery), University of Western Ontario, London, Ontario (N.D.), Canada

Reprints: Ibrahim Omeis, MD, Department of Neurosurgery, New York Medical College, Munger Pavilion, 3rd Floor, Valhalla, NY 10595 (e-mail:

Received for publication December 1, 2007; accepted March 1, 2008

© 2009 Lippincott Williams & Wilkins, Inc.