# Treatment practices for geriatric type II odontoid fractures – A survey by the European Association of Neurosurgical Societies Spine Section

## TL;DR

This survey explores how spine surgeons treat type II odontoid fractures in elderly patients, revealing both consistent and varying practices.

## Contribution

The study provides insights into current treatment preferences for geriatric type II odontoid fractures among European spine surgeons.

## Key findings

- Conservative treatment is more common for non-displaced fractures in patients aged 70–90 years.
- Surgical preference decreases for displaced fractures in patients over 80 years.
- Posterior C1-2 fixation is the most common surgical technique used.

## Abstract

Controversy exists regarding the optimal management of type II odontoid fractures in the geriatric population. The objective of this study was to determine the current treatment patterns of spine surgeons for geriatric patients (≥70 years) with type II odontoid fractures.

How much do treatment practices for type II odontoid fractures in the geriatric population differ amongst spine surgeons?

The European Association of Neurosurgical Societies (EANS) Spine Section distributed a 39-items web-based survey among spine surgeons between July 2024 and February 2025.

A total of 154 responses were collected from 119 neurosurgeons (77.8 %) and 34 orthopedic surgeons (22.2 %). Participants were predominantly from Europe (92.7 %), and 63.2 % have been in practice >10 years. Fracture displacement, comorbidities and age were the most influential factors for decision-making. For non-displaced fractures, 78.8 % of respondents recommended conservative treatment for patients aged 70–80 years, and 83.7 % for those aged 80–90 years. For displaced fractures, 70.9 % preferred surgery for patients aged 70–80 years, whereas this preference decreased to 47.9 % for those aged 80–90 years. Posterior C1-2 fixation was the most common technique for 67.3 % of respondents, and 48.3 % prescribe a collar postoperatively. 51.3 % routinely order CT imaging postoperatively to assess for bony fusion. For conservative treatment, 59.3 % prescribe an external orthosis for 3 months.

Our survey found both variability and consistency in treatment practices of geriatric type II odontoid fractures, reflecting the ongoing debate and lack of consensus in clinical decision-making.

•Survey shows both variability and consistency in treating geriatric type II odontoid fractures.•Posterior C1-2 fusion preferred for stability in younger geriatric patients.•Nonoperative care remains common in frail or high-risk elderly individuals.•Standardized global guidelines are needed to improve consistency in care.

Survey shows both variability and consistency in treating geriatric type II odontoid fractures.

Posterior C1-2 fusion preferred for stability in younger geriatric patients.

Nonoperative care remains common in frail or high-risk elderly individuals.

Standardized global guidelines are needed to improve consistency in care.