Failure of conservative treatment can be safely addressed with surgical fixation at a later stage. This study showed that a conservative approach to odontoid Type II fracture in elderly is an effective and valid option, resulting in an excellent functional outcome (regardless of bony fusion) in the majority of cases. The residual 5% were still variably symptomatic at 12 weeks however, only 5 out of 13 (2% of the total cohort) required delayed surgery. Patients were followed up for a minimum of 24 months: 247 (95%) showed an excellent functional outcome within 6 weeks, among them 117 (45%) showed a good bony healing, whereas 130 (50%) healed in pseudo-arthrosis. Among the 260 patients enrolled, 177 (68%) were women and 83 (32%) men, with a median age of 83 years. All patients were clinically evaluated by Neck Disability Index (NDI), Charlson Comorbidity Index (CCI), and American Society of Anaesthesiologists classification (ASA) on admission NDI was assessed also at 6 weeks, 3, 6, 12, and 24 months furthermore, a quality of life (QoL) assessment with the SF-12 form was performed at 3 and 12 months. All patients underwent CT scan on admission and at 3 months if indicated, selected patient had CT scan at 6 and 12 months. Observational multicenter study was conducted on a prospectively built database on elderly patients (> 75 years) with Type II odontoid fracture managed conservatively during the last 10 years. External immobilization is the treatment of choice for Type I and III there is still no wide consensus about the best management of Type II fractures. Odontoid fractures constitute the most common cervical fractures in elderly.
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