title: Odontoid fractures with neurologic deficit have higher mortality and morbidity.
abstract: BACKGROUND
  Type II odontoid fractures are reportedly increasing in incidence and occur primarily in the elderly. Neurologic deficits (ND) at presentation add to the morbidity of these fractures; however, reports are limited as a result of small case series. It is unclear what specific complications are associated with ND and whether these result in increased incidence of mortality.
  
  
  OBJECTIVE
  We established the incidence of ND with Type II odontoid fractures and determined if ND are associated with increased inpatient mortality and morbidity during hospitalization.
  
  
  METHODS
  Twenty patients with acute Type II odontoid fracture and ND were identified from our institutional database. Baseline presenting characteristics and hospital course data were collected. The cohort was compared with a previously published cohort of 188 patients without ND by age, mechanism of injury, displacement, associated spinal injuries, comorbidities, treatment, mortality, and complications. Patients were only followed during acute-care hospitalization (mean, 11.9 days; range, 0-41 days).
  
  
  RESULTS
  The incidence of ND among all Type II odontoid fractures was 9.6%. Ten of 20 patients with Type II odontoid fractures and ND died during hospitalization, and patients with complete cord injuries were 9.33 (95% confidence interval, 1.19-73.0) times more likely to die. Patients with ND experienced more complications and more respiratory complications than those without ND.
  
  
  CONCLUSIONS
  ND after Type II odontoid fractures is a rare event associated with a high risk of early and rapid clinical decline.
  
  
  METHODS
  Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Amar
authors.initials: A
authors.lastname: Patel
authors.forename: Harvey E
authors.initials: HE
authors.lastname: Smith
authors.forename: Kris
authors.initials: K
authors.lastname: Radcliff
authors.forename: Navin
authors.initials: N
authors.lastname: Yadlapalli
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D009809:Odontoid Process / Q000293:injuries*; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications / Q000401:mortality*