title: Functional outcomes, morbidity, mortality, and fracture healing in 26 consecutive geriatric odontoid fracture patients treated with posterior fusion.
abstract: METHODS
  Retrospective review.
  
  
  OBJECTIVE
  To evaluate functional outcomes, fracture healing, complications, and mortality associated with posterior fusion surgery (PSF) for the management of geriatric type II odontoid fractures.
  
  
  BACKGROUND
  Outcomes of C1-2 fusion for geriatric odontoid fractures are not well defined.
  
  
  METHODS
  Twenty-six consecutive elderly patients with type II odontoid fractures were treated by the same spinal surgeon at a Level-1 trauma center during an 8-year period. All patients had ≥50% odontoid displacement and were treated with PSF including C1-2 (PSF group; average age, 79 y). Chart reviews were performed evaluating patient comorbidities, treatment complications, and mortality rates. At ultimate follow-up, patients had open mouth, flexion, and extension radiographs to assess fracture stability and healing. In addition, functional outcomes were assessed using Neck Disability Index (NDI), analog pain, and satisfaction questionnaire scores and compared with a group of 40 aged-matched control patients (control group; average age, 79.8 y).
  
  
  RESULTS
  The mortality rate was 19.2%, and major complications occurred in 27% of patients. At an average 13-month follow-up (range, 3-48 mo), the fracture-healing rate was only 33%. However, no patient had mobile odontoid nonunion or instability of the C1-2 articulation. NDI scores averaged 18.1 points indicating only mild residual disability. Pain scores were low averaging only 1.8 points. NDI and pain scores did not differ significantly from aged-matched controls (P = 0.16). Treatment satisfaction scores were high. Odontoid nonunion was not associated with significantly higher levels of disability or neck pain and did not affect scores for patient satisfaction.
  
  
  CONCLUSIONS
  PSF for geriatric odontoid fractures is associated with moderately high levels of morbidity and mortality. Posttreatment neck pain and disability is low and does not differ significantly from aged-matched cohorts. Odontoid fracture healing after surgical stabilization does not correlate with improved functional outcomes.
authors.affiliation: Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642, USA. bobmol@aol.com
authors.forename: Robert William
authors.initials: RW
authors.lastname: Molinari
authors.forename: Jason
authors.initials: J
authors.lastname: Dahl
authors.forename: William L
authors.initials: WL
authors.lastname: Gruhn
authors.forename: William J
authors.initials: WJ
authors.lastname: Molinari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery; D005260:Female; D017102:Fracture Healing / Q000502:physiology*; D006801:Humans; D008297:Male; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000401:mortality / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome