Background: Odontoid fractures are the most common type of axis injury. Elderly patients can develop odontoid fractures after minor trauma with hyperextension injuries. The optimal treatment of type II fractures is controversial.

Methods: A case of catastrophic failure of conservative treatment for a type II odontoid fracture in an elderly patient is presented. The patient presented six years after initial diagnosis and treatment of the fracture in a collar, with an acute SCI due to progressive instability and stenosis.

Results: Cervical Spine imaging revealed a posterior displaced type II odontoid fracture with sclerotic margins, severe stenosis at the level of C2-3 with cord compression and intrinsic cord signal abnormality.

Conclusion: Type II odontoid fractures have a high rate of non-union with non-surgical treatment and can result in cervical instability and spinal cord injury. Treatment options in the increasing elderly population with cervical spin trauma should include close observation in rigid immobilization as well as potential surgical fixation.

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