What is the efficacy of surgery for type II C2 fractures?

Updated: Sep 28, 2020
  • Author: Igor Boyarsky, DO, FACEP, FAAEM; Chief Editor: Jeffrey A Goldstein, MD  more...
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There has been some controversy regarding operative versus nonoperative management of type II fractures. Vaccaro et al, in a study of 159 elderly patients with type II dens fractures, reported a significant benefit with surgical treatment and recommended that elderly patients with such fractures who are healthy enough for general anesthesia be considered for surgical stabilization. [17]

The investigators from the AOSpine North America Geriatric Odontoid Fracture Mortality Study did not find operative treatment of type II fractures to have a negative impact on survival in 322 elderly patients with type II fractures, even after age, sex, and comorbidities had been adjusted for. [18]  In this study, operative treatment had a significant advantage in 30-day survival advantage, and a trend toward improved longer-term survival was noted.

Paolo et al examined 108 consecutive type II fractures, of which 60 were conservatively treated with external immobilization and 48 surgically treated . [19]  They concluded that all odontoid fractures without dislocation should be treated with rigid external immobilization and that all odontoid fractures with dens dislocation exceeding 5 mm should be considered for surgery. They further suggested that type II fractures in patients older than 50 years should also be considered for surgery; outcomes with conservative treatment are better for patients younger than 50 years.

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