Management of Odontoid Cervical Fracture

Fractures of the cervical odontoid process are the most common fractures of the cervical tract, accounting for one third of all cervical spine fractures. They are more frequent in elderly patients, and with the aging of the world population, their incidence and clinical and social relevance are expected to increase in the near future. The mechanisms underlying odontoid fractures differ according to patient age, with high-energy mechanisms being the causative factor frequently encountered in younger patients and low-energy trauma commonly occurring in elderly patients. Despite rising incidence and costs, there is considerable uncertainty regarding the optimal management for these fractures, especially in elderly patients. On one hand, poor bone health and medical comorbidities in elderly patients contribute to increased surgical risk. On the other hand, nonoperative management can be associated with a risk of nonunion, resulting in complications. The balance between these options is a difficult challenge, which is completely left to the discretion of the surgeon, as validated guidelines are still missing.