title: A Systematic Review of the Treatment of Geriatric Type II Odontoid Fractures.
abstract: BACKGROUND
  Odontoid fractures are the most common cervical spine fracture in the geriatric population; however, the treatment of type II odontoid fractures in this age group is controversial.
  
  
  OBJECTIVE
  To compare the short-term (<3 months) mortality, long-term (≥12 months) mortality, and complication rates of patients >60 years of age with a type II odontoid fracture managed either operatively or nonoperatively.
  
  
  METHODS
  We performed a systematic review of literature published between January 1, 2000, and February 1, 2015, related to the treatment of type II odontoid fractures in patients >60 years of age. An analysis of short-term mortality, long-term mortality, and the occurrence of complications was performed.
  
  
  RESULTS
  A total of 452 articles were identified, of which 21 articles with 1233 patients met the inclusion criteria. Short-term mortality (odds ratio, 0.43; 95% confidence interval, 0.30-0.63) and long-term mortality (odds ratio, 0.47; 95% confidence interval, 0.34-0.64) were lower in patients who underwent surgical treatment than in those who had nonsurgical treatment, and there were no significant differences in the rate of complications (odds ratio, 1.01; 95% confidence interval, 0.63-1.63). Surgical approach (posterior vs anterior) showed no significant difference in mortality or complication rate. Similarly, no difference in mortality or complication rate was identified with hard collar or a halo orthosis immobilization.
  
  
  CONCLUSIONS
  The current literature suggests that well-selected patients >60 years of age undergoing surgical treatment for a type II odontoid fracture have a decreased risk of short-term and long-term mortality without an increase in the risk of complications.
authors.affiliation: *Rothman Institute at Thomas Jefferson University, Department of Orthopedic Surgery, Philadelphia, Pennsylvania; ‡Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania; §Department of Orthopedic Surgery, University of Utah, Salt Lake City, Utah; ¶Swedish Neuroscience Institute, Department of Orthopedic Surgery, Seattle, Washington.
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Kepler
authors.forename: Mark F
authors.initials: MF
authors.lastname: Kurd
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Paul
authors.forename: Robyn N
authors.initials: RN
authors.lastname: Rubenstein
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Darrel S
authors.initials: DS
authors.lastname: Brodke
authors.forename: Jens R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008875:Middle Aged; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery; D016103:Spinal Fractures / Q000145:classification / Q000628:therapy*; D016896:Treatment Outcome