Global Spine J 2013;3:21–32.

Odontoid fractures are the most common of all spinal frac-tures for patients older than 70 years of age. These fractures typically present significant challenges as geriatric patients often have multiple clinical comorbidities that may adversely affect fracture management. Numerous studies have demon-strated high rates of mortality with these injuries in elderly patients regardless of intervention.1–4 Treatment options for displaced odontoid fracturesmay be conservative or surgical. Alternatives include the use of a cervical collar, halo vest, posterior C1–2 fusion with rigid fixation, and odontoid screw fixation. Presently, there is no consensus regarding which method is most efficacious. Ex-ternal immobilization with a collar has had inconsistent reported results.5–8 Halo vest immobilization in the elderly is associated with significant complications, increased mor-bidity, and high rates of nonunion.3 In addition, elderly patients having surgery for type II odontoid fractures have a higher risk of complications including mortality.9 Management of geriatric patients with odontoid fracture should be focused on rapid mobilization of the patient in a collar or after surgical stabilization. Many spinal trauma specialists feel the halo vest should be avoided in thi