Survival and quality of life after treatment of geriatric odontoid fractures.

Abstract

Odontoid fractures are the most common cervical spine injuries in geriatric patients and are associated with substantial morbidity and mortality. Their incidence is increasing with population aging. Optimal management remains controversial, particularly due to poor bone quality and comorbidities in this patient group. While surgical treatment is associated with lower nonunion rates, its impact on survival and patient-reported outcomes is unclear. This retrospective single-center study included patients with odontoid fractures who were treated conservatively or surgically between 2017 and 2020. Demographic and clinical data were obtained from medical records. Survival was analyzed using Kaplan-Meier estimates and Cox regression. Health-related quality of life was evaluated in surviving patients using Visual Analog Scale (VAS), Neck Disability Index (NDI), and Short Form-36 (SF-36) questionnaires. Comorbidity burden was determined using the age-adjusted Charlson Comorbidity Index (CACI). A total of 93 patients were included. The mean age was 78.9 ± 13.7 years, and 75% of fractures were Type II. Surgical treatment was performed in 59% of patients, whereas 41% received conservative management, primarily due to comorbidities. The 1-year mortality rate was 26.9% and increased with age and comorbidity burden. Higher CACI scores and conservative treatment were associated with reduced survival. Among 40 respondents, pain levels were low (mean VAS 2.5 ± 2.4). Conservatively treated patients reported significantly lower pain and higher SF-36 scores, while no significant differences were observed in NDI between groups. Odontoid fractures in geriatric patients are associated with substantial morbidity and mortality. Surgical treatment showed improved survival, whereas conservative management resulted in better patient-reported quality of life. These findings emphasize a clinically relevant contrast and support individualized, patient-centered treatment decisions based on comorbidity burden and overall patient condition.