Risk factors affecting the outcome of upper cervical spine injuries in the elderly - role of operative vs. conservative treatment.

STUDY DESIGN: Retrospective Cohort Study. OBJECTIVES: To evaluate risk factors for adverse outcome and complications of elderly patients with upper cervical spine fracture following conservative or surgical treatment. METHODS: 141 cases of elderly patients (≥ 65 years) admitted between 01/2013 and 12/2015 with upper cervical spine injuries were retrospectively analyzed through our prospectively collected database. Median follow-up was 113.5 days (IQR: 21–393). RESULTS: With a collective median age of 79, operatively treated patients (41%, 58/141) were younger compared to conservatively treated (76 vs. 83 years, p < 0.001). Ground level falls were the most common injury mechanism (55% vs. 54%, p = 0.91) while Anderson type II (29.1%) and combined odontoid/atlas fractures (28.2%) were the most frequent injury patterns. Complications were significantly increased in operated patients (67% vs. 49%, p = 0.035) when compared to those conservatively treated. Neurological and rheumatic comorbidities, as well prolonged operation time, had a significant association to postoperative delirium. The duration of surgery (47 vs. 59 min, p = 0.014) and the risk for secondary dislocation (22% vs. 60%, p = 0.086) were reduced through posterior C1-2 screw fixation, as compared to anterior direct osteosynthesis. CONCLUSION: Considerations regarding appropriate treatment of upper cervical spine injuries include age, comorbidities and individual risk factors as well as injury patterns. As results for initial conservative treatment in geriatric patients show promising results, indication for operative management should be strict and duration of surgery kept minimal.