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Type II Odontoid Fracture in a Nonagenarian

To the Editor: The elderly spine, weakened by age-related degeneration and osteoporosis, is inherently prone to upper cervical trauma associated with low-energy injuries. The junction between the body of axis and the odontoid process is most vulnerable, and fractures across this junction, known as type II odontoid fractures, are the most common spinal fractures for individuals aged 80 and older. Because of the associated ligamentous disruption, type II odontoid fracture is generally considered unstable. Despite this, controversy remains regarding its optimal management in elderly adults. Significant variability exists in clinical practice, from the minimalist approach of harm reduction and palliation to advocacy of early surgery to avoid fatal complications and facilitate early rehabilitation. A case of a nonagenarian who sustained a displaced type II odontoid fracture is presented. Despite his extreme old age and comorbidities, he made an excellent recovery through aggressive early surgical treatment. This favorable surgical outcome, despite the perceived risks and futility, highlights the dangers of withholding potentially lifesaving surgical intervention in extremely elderly adults.