Medical Student Department of Neurosurgery, University of Illinois at Chicago Chicago, IL, US
Introduction: Fractures of the second cervical vertebrae (C2) represent a challenging diagnosis for elderly patients. Historically, surgeons have favored conservative management in these patients given the high rate of comorbid health conditions that may complicate postoperative recovery. In recent years, there has been increasing literature suggesting that elderly patients may benefit from surgical treatment compared to conservative management. The purpose of this study is to evaluate the nationwide trends in operative treatment of C2 fractures over a 5-year period within the past decade.
Methods: The National Trauma Data Bank was searched from 2017 to 2021 for all elderly (65+) patients with a C2 fracture. Surgical treatment was defined as surgical fixation and fusion, while all others were defined as conservative management. The primary outcome was the rate of surgical treatment. Pearson’s χ2 and analysis of variance tests were used to compare differences across years. Bejamini-Hochberg multiple comparisons correction was performed. A subgroup analysis was performed among octogenarians (80+).
Results: In total, 44078 patients met the inclusion/exclusion criteria. There were 7980, 8551, 9032, 8776, and 9739 patients each year from 2017 to 2021. The rate of unstable fractures, defined as odontoid type II or hangman type 3, remained consistent across all five years (42-43%, p=0.35). The rate of surgical treatment increased significantly, with rates of 9.59%, 10.29%, 10.25%, 11.04%, and 11.05% (p=0.049) each year, respectively. Among octogenarians, the rate of unstable fractures was higher but stable (47-48%, p=0.16). Surgical treatment did not change significantly over time, with rates of 6.91%, 7.63%, 6.48%, 7.40%, and 7.26% (p=0.4), respectively.
Conclusion : From 2017-2021, the rate of surgical treatment for elderly patients with C2 fractures increased steadily from 9.59% to 11.05%. This trend was not seen in octogenarian patients, which fluctuated between 6.91% and 7.63%. This suggests that surgical intervention is becoming an increasingly popular treatment modality among spine surgeons in elderly patients younger than 80. Further research is warranted to study the long-term effects of surgery and determine the optimal treatment in older patients.
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