Single Institute Experience on 108 Consecutive Cases of Type II Odontoid Fractures: Surgery Versus Conservative Treatment

AIM: The incidence of cervical fractures in industrialized countries is about 11.000 cases per year. The objective of our study was to determine which of two treatments was more effective for the management of Type II odontoid fractures. MATERIAL and METHODS: This study involved 108 cervical fractures treated at the "Department of Neurosurgery of Policlinico Umberto l" in Rome between 2002 and 2013. Sixty of the 108 axis fractures were treated conservatively with external immobilization, and the remaining 48 were treated surgically. RESULTS: Patients undergoing surgery had a higher rate of fusion (91.67% vs. 46.67%) and shorter bone healing times (17 weeks compared to 21 weeks) than the patients who received conservative treatment. CONCLUSION: All fractures of the odontoid process, without dislocation, should be treated with rigid external immobilization (preferably with a "Halo-vest"). All fractures of the odontoid process with dens dislocation >5 mm should be considered as candidates for surgery. Type II odontoid fractures in patients over 50 years old should also be candidates for surgical treatment, while the outcome of such fractures, as regards conservative treatment, is better for patients under 50 years old.