Early mortality in elderly patients with isolated C2 odontoid fracture treated by halo-vest immobilization, anterior spinal fixation, or posterior spinal fixation: A generalized propensity score-based analysis using a nationwide database

Purpose: To compare in-hospital mortality of three procedures in the treatment of elderly patients with isolated C2 odontoid fracture: halo-vest immobilization, anterior spinal fixation (ASF), and posterior spinal fixation (PSF). Methods We extracted data for elderly patients who were admitted with C2 odontoid fracture and treated with at least one of the three procedures (halo-vest immobilization, ASF, or PSF) during hospitalization. We conducted a generalized propensity score-based matching weight analysis to compare in-hospital mortality among the three procedures. We further investigated independent risk factors for in-hospital death. Results The study involved 891 patients (halo-vest, n = 463; ASF, n = 74; and PSF, n = 354) with a mean age of 78 years. In-hospital death occurred in 45 (5.1%) patients. Treatment type was not significantly associated with in-hospital mortality. Male sex (odds ratio, 2.98; 95% confidence interval, 1.32–6.73; p  = 0.009) and a Charlson comorbidity index of ≥ 3 (odds ratio, 9.18; 95% confidence interval, 3.25–25.92; p  < 0.001) were independent risk factors for in-hospital mortality. Conclusions Treatment type (halo-vest immobilization, ASF, or PSF) was not significantly associated with in-hospital mortality in elderly patients with isolated C2 odontoid fracture. Halo-vest immobilization can help to avoid adverse events in patients with C2 odontoid fracture who are considered less suitable for surgical treatment.