Challenges of Treating a C2 Odontoid Fracture in an Elderly Patient With Multiple Comorbidities: A Case Report

Abstract

An 88-year-old male with a history of cervical spondylosis (status post laminectomy of C2-C3 and laminoplasty of C4-C5), chronic congestive heart failure (CHF), pulmonary embolism, and lumbar spinal stenosis presented to an outpatient sports medicine clinic with neck pain following a fall five days prior due to loss of balance. He reported pain on the left side worsened by movement and accompanied by neck "clicking." A physical exam showed severe limitation in cervical spine extension limited by pain and loss of lordotic curve and a neurologic exam demonstrated weakness in the left leg secondary to a previous back surgery. A cervical spine X-ray revealed multilevel degenerative changes without evidence of fracture. To rule out a fracture, computed tomography (CT) was completed and revealed a new fracture at the odontoid process and the C2 right pars interarticularis. The consulting orthopedist recommended operative management due to the risk of atlantoaxial instability. Unfortunately, the patient experienced an acute episode of atrial fibrillation that worsened his CHF. With an overall heavy burden of medical comorbidities, the patient chose to receive hospice care and is being managed non-operatively. Type II odontoid fractures in the geriatric population require a complex risk/benefit analysis necessitating a collaborative approach in support of the patient's health goals.

Keywords: cervical orthosis; comorbid conditions; fracture pain management; geriatric fracture; odontoid process fracture; orthopedic sports medicine; physical medicine & rehabilitation.

Figure 1. Cervical X-ray findings revealed multilevel degenerative changes (indicated by yellow arrows) without evidence of fracture.

Figure 2. New fracture at the odontoid process (Type II)(image A) and the right C2 pars interarticularis (image B) with a grade 1, 7mm anterolisthesis of C2 on C3