Management of type II odontoid fractures in adults

Fractures of the odontoid represent as much as 20% of cervical spine fractures in adults, and they are the most common spine fracture in patients over 80 years of age. Despite their prevalence, the management of these fractures remains highly controversial. In particular, there is much debate concerning the management of type II fractures, or fractures occurring about the waist of the odontoid. We will review the epidemiology, evaluation, management-both operative and non-operative-and outcomes of adults with type II odontoid fractures. We will particularly focus on debates concerning hard collar versus halo, anterior versus posterior surgery, the management of odontoid nonunions, as well as questions about risks and benefits of surgery in the very elderly.