“Successful delayed fracture healing of a type-II odontoid fracture following posterior C1-C2 salvage fusion in an elderly patient: case report”

• Type II odontoid fractures failing anterior odontoid screw fixation can heal with posterior salvage fusion. • An osteopenic, elderly patient can still heal a type II odontoid fracture with surgery performed several months after injury. • The treatment for elderly patients with a type II odontoid fracture remains a challenging and controversial topic. Non-operative vs. operative management of type II odontoid fractures in the elderly remains a controversial and challenging topic. An abundance of literature exists concerning advantages and disadvantages of non-operative management vs. anterior or posterior surgical treatment options. However, there remains a paucity of literature concerning outcomes following posterior salvage surgery for failed anterior odontoid screw fixation surgery in the elderly. In this report we describe the case of a 71-year-old female initially treated with anterior screw fixation, who presented several months later with a recurrent symptomatic, non-healing fracture. A posterior instrumented C1-C2 fusion was performed 7 months following the initial injury. Subsequent fracture healing occurred despite increasing fracture diastasis following anterior screw fixation surgery with resolution of her recurrent neck pain.