Evaluation of 2D and 3D Measurements of Cervical Sarcopenia and Outcomes in Patients with Acute Type II Odontoid Fractures: A Single-Institution Retrospective Cohort Analysis.

Abstract

Due to an aging population, incidences of Anderson Type 2 Odontoid fractures (T2OF), a type of spinal fragility fracture, are increasing. Elderly populations have high rates of sarcopenia, an age-related condition characterized by loss of muscle mass and function, which has been tied to outcomes after spine surgery and has been related to worse functional status and worse fracture healing. No prior studies have explored the relationship between cervical sarcopenia and outcomes following T2OF, which may aid with surgical decision-making in this complex patient population. This study was a retrospective single-center cohort analysis. Adult patients presenting with acute T2OF after trauma from 2013-2025 were included. Demographics, comorbidities, surgical data, and clinical outcome and imaging data were collected. Cervical skeletal muscle measurements were performed both 2-dimensionally at the C3 level, which was then converted to lumbar skeletal muscle index and then stratified as sarcopenic or non-sarcopenic, and 3-dimentionally via skeletal volume measurements from the top of C1 to the bottom of C7 (cSMV). Univariable analyses were performed using χ² or Fisher exact tests for categorical variables and analysis of variance or Kruskal-Wallis tests for continuous variables, and multivariable outcomes were assessed using Cox proportional hazards regression models and survival functions by the Kaplan-Meier method. Sarcopenic patients were significantly older, more likely to be female, had lower BMI, were more likely to have T2OF from a fall, and had significantly lower cSMV. Patients with sarcopenia and lower cSMV were less likely to fail non-operative management, and we did not detect an association between sarcopenia and cSMV and 1-year mortality. Sarcopenia and cSMV both seem to carry valuable prognostic information regarding success of non-operative management of T2OF, encoding information about patient frailty and functional status beyond age and comorbidity burden. This warrants further exploration in larger multi-center cohorts.