• Yi-Ren Chen, Maxwell Boakye, Robert T Arrigo, Paul S A Kalanithi, Ivan Cheng, Todd Alamin, Eugene J Carragee, Stefan A Mindea, and Jon Park.
• Stanford University School of Medicine, Stanford, California, USA.
• Neurosurgery. 2012 May 1; 70 (5): 1055-9; discussion 1059.

BackgroundClosed C2 fractures commonly occur after falls or other trauma in the elderly and are associated with significant morbidity and mortality. Controversy exists as to best treatment practices for these patients.ObjectiveTo compare outcomes for elderly patients with closed C2 fractures by treatment modality.MethodsWe retrospectively reviewed 28 surgically and 28 nonsurgically treated cases of closed C2 fractures without spinal cord injury in patients aged 65 years of age or older treated at Stanford Hospital between January 2000 and July 2010. Comorbidities, fracture characteristics, and treatment details were recorded; primary outcomes were 30-day mortality and complication rates; secondary outcomes were length of hospital stay and long-term survival.ResultsSurgically treated patients tended to have more severe fractures with larger displacement. Charlson comorbidity scores were similar in both groups. Thirty-day mortality was 3.6% in the surgical group and 7.1% in the nonsurgical group, and the 30-day complication rates were 17.9% and 25.0%, respectively; these differences were not statistically significant. Surgical patients had significantly longer lengths of hospital stay than nonsurgical patients (11.8 days vs 4.4 days). Long-term median survival was not significantly different between groups.ConclusionThe 30-day mortality and complication rates in surgically and nonsurgically treated patients were comparable. Elderly patients faced relatively high morbidity and mortality regardless of treatment modality; thus, age alone does not appear to be a contraindication to surgical fixation of C2 fractures.

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