Halo-Vest Immobilization in Elderly Odontoid Fracture Patients Evolution in Treatment Modality and In-Hospital Outcomes

Study Design: Retrospective cohort study. Objective: To evaluate the utilization and effectiveness of halovest (HV) immobilization for type II odontoid fractures from 2004 to 2014. Summary of Background Data: Controversy persists regarding the optimal treatment method for odontoid fractures in the elderly. Management options include immobilization in a cervical orthosis, HV immobilization, and operative intervention. Over the past decade, high mortality and morbidity rates have been reported following HV immobilization in this patient population. Materials and Methods: In a retrospective study, patient demographics, presentation, Charlson comorbidity index, treatment method, and outcome data for patients over 65 who had suffered type II odontoid fractures from 2004 to 2014 were compared with a historical cohort from 1997 to 2004. Results: One hundred twenty-six patients met inclusion criteria. The mean age was 82.7 +/- 8.8 compared with 80.7 +/- 0.9 in the 1997-2004 cohort. The in-hospital mortality rate from 2004 to 2014 was 11.1% (14/126) compared with 31% in the historical cohort, and 10 (7.9%) patients were treated with HV compared with 49%. Mortality in the HV group was higher than the surgical group (P = 0.01) but no different from the orthosis group (P = 0.63). There were no differences in injury severity score, Charlson comorbidity index, or complications between treatment groups. Conclusions: Over the past decade, HV use for elderly odontoid fractures has decreased at our institution. Mortality and morbidity of elderly patients treated with HV has also decreased. These findings are likely the result of improved patient selection and greater attention to respiratory care. This study demonstrates that HV immobilization of odontoid fractures in elderly patients can be as safe as cervical orthosis treatment in select patients.