Odontoid Fracture in Patients Age >75 Years Surgically Managed by the Harms Technique: Bone Healing and 1-Year Mortality Rate in 57 Cases

Odontoid fracture is the most common lesion of the cervical spine in persons age >70 years. Management of these fractures has become a public health issue. In this study, we evaluated bone fusion, early complications, and mortality in a cohort of patients age >75 years who underwent surgical management of odontoid fracture using the Harms technique. This study is a retrospective analysis of 57 patients treated surgically between 2002 and 2016 in a single spine surgery institution. Age at diagnosis, comorbidities, and American Society of Anesthesiologists (ASA) score were analyzed. At a 6-month follow-up, bone healing was evaluated with computed tomography scans. The mean patient age was 85.5 ± 6.6 years, and 53% of the patients had an ASA score ≥3. According to the Anderson classification, 70% of the patients had a type 2 odontoid fracture. The average duration of follow-up was 15.7 months. Ten patients were lost to follow-up. The rate of early complications was 19%, with no mechanical complications reported. At a 6-month follow-up, a solid bony union was seen in all patients. The 1-year mortality was 14%. Surgical management of odontoid fractures in elderly patients using the Harms technique is associated with an excellent rate of bone healing with acceptable rates of early complications and mortality. •Fractures of the dens are common in elderly individuals.•Surgical management in elderly patients is associated with an excellent fusion rate.•The Harms technique is safe and provides good mechanical stability with a low rate of complications.