Comparative Outcomes of Surgical Versus Conservative Management for C2 Fractures in Elderly Patients: A Systematic Review and Meta-Analysis.

Abstract

Systematic review and meta-analysis of comparative outcomes. To evaluate the effectiveness of surgical versus conservative management for C2 fractures in patients aged 60 years or older. C2 fractures are common cervical spine injuries in elderly populations, with ongoing debate regarding optimal management strategies. Previous studies have reported conflicting outcomes regarding fracture healing, stability, and mortality between treatment approaches. Following PRISMA guidelines, we analysed 102 studies (84,366 patients). Primary functional outcomes included the Neck Disability Index and Visual Analog Scale pain score. Secondary outcomes comprised fracture stability, union rates, complications, and mortality (30 d, 3 mo, and 1 y). Surgical management demonstrated superior fracture union (82.75% vs. 43.95%, P<0.001) and stability rates (86.40% vs. 72.02%, P<0.001) compared with conservative treatment. Pneumonia was the most common complication (surgical: 4.60%; conservative: 2.94%). Surgical patients had significantly lower mortality rates at 30 days (7.72% vs. 21.86%), 3 months (10.97% vs. 21.09%), and 1 year (28.08% vs. 31.57%) (all P<0.001). Surgical treatment for C2 fractures in elderly patients is associated with improved fracture healing, stability, and reduced mortality compared with conservative management. Treatment decisions should consider individual patient risk factors and surgical suitability.