• Timothy Lukins, Lana Nguyen, Mitchell A Hansen, and Richard D Ferch.
• John Hunter Hospital, Newcastle, NSW, Australia. timothy.lukins1@my.nd.edu.au.
• Eur Spine J. 2021 Jun 1; 30 (6): 1551-1555.

ObjectiveCompare short-term mortality rates following operative and nonoperative management of geriatric patients following an acute type II odontoid process fracture.MethodsOne hundred forty-one patients with a type II odontoid fracture were identified from a single centre between 2002 and 2018. Patient demographics, details of injury and management, plus mortality data were collected. The incidence of mortality at 3 and 12 months was calculated, and a multivariate model built which included the treatment modality variable and allowed adjustment for six individual confounders.ResultsOf the 141 patients with a type II odontoid process fracture, 39 were managed operatively, while 102 were managed nonoperatively. Relative to the nonoperative group, the operative group was younger (79.0 ± 7.0 vs. 83.7 ± 7.6), more likely to have odontoid angulation > 15° (74.4% vs. 43.1%, p < 0.01), and a greater proportion having fracture displacement > 2 mm (74.4% vs. 31.4%, p < 0.01). Both groups were comparable for gender, comorbidities, and associated injuries. On univariate analysis of treatment modality, the odds ratio of 3-month mortality with nonoperative management was 2.55 (95% CI: 0.82-7.92; p = 0.08), whilst at 12-months it was 3.12 (95% CI: 1.11-8.69; p = 0.02). On multivariate analysis of 12-month mortality, however, treatment modality was not found to be significant. This multivariate analysis suggested that increasing age, male gender, and injury severity were significant predictors of 12-month mortality.ConclusionIn contrast to the findings of a number of previous studies, operative management may not influence survival at 3- and 12-months.© 2021. Crown.

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