title: Odontoid fractures in the octogenarian: a systematic review and meta-analysis.
abstract: BACKGROUND
  Odontoid fractures (OF) are the most frequent cervical spine fracture type in the elderly, often following low-velocity falls. The rise in life expectancies has led to an increase in octogenarians suffering OF, for which the optimal treatment remains undetermined.
  
  
  METHODS
  A comprehensive search was conducted (National Library of Medicine MEDLINE, Cochrane Central Register of Controlled Trials) for all articles through 03/2016. Articles were included if the study population evaluated treatment modalities in OF patients aged ≥80-years. Outcomes assessed were mortality, complications, osseous union, and fracture stability. Pooled odds ratios (OR) and 95% confidence intervals (CI) are reported.
  
  
  RESULTS
  Across 22 case series/retrospective studies, attributable mortality for surgery was 5.4% (8/149) vs. 10.1% (10/99) for nonsurgery (P=0.159). Surgery patients suffered higher complications rates (38.9%, 58/149; vs. 24.5%, 26/106); OR 1.96 ([1.13-3.40], P=0.016). Osseous union was better achieved with surgery (68.5%, 37/54; vs. 43.2%, 16/37); OR 2.86 ([1.20-6.80]; P=0.016). Fracture stability was better achieved with surgery (86.0%, 49/57; vs. 63.6%, 28/44); OR 3.50 ([1.33-9.21], P=0.009).
  
  
  CONCLUSIONS
  In general, octogenarians undergoing surgery for OF showed higher fusion and stability rates compared to nonsurgery, which may be due in part to surgical selection criteria, surgeon preference and patient comorbidities. Higher complications were observed for surgery patients, while no differences were observed for mortality. Prospective trials are greatly needed to identify the optional treatment modality and predictors of clinical outcome in octogenarians suffering OF.
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA, USA - sanjay.dhall@ucsf.edu.
authors.forename: Hansen
authors.initials: H
authors.lastname: Deng
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.forename: Pavan S
authors.initials: PS
authors.lastname: Upadhyayula
authors.forename: John F
authors.initials: JF
authors.lastname: Burke
authors.forename: Catherine G
authors.initials: CG
authors.lastname: Suen
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Chan
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.forename: Sanjay S
authors.initials: SS
authors.lastname: Dhall
mesh_terms: D000369:Aged, 80 and over / Q000502:physiology; D000375:Aging; D066193:Cervical Cord / Q000601:surgery*; D006801:Humans; D009809:Odontoid Process / Q000601:surgery*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome