{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:09:05Z","timestamp":1779527345679,"version":"3.53.1"},"reference-count":74,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECT<\/jats:title>\n                    <jats:p>Incidence of C-2 fracture is increasing in elderly patients. Patient age also influences decision making in the management of these fractures. There are very limited data on the national trends of incidence, treatment interventions, and resource utilization in patients in different age groups with isolated C-2 fractures. The aim of this study is to investigate the incidence, treatment, complications, length of stay, and hospital charges of isolated C-2 fracture in patients in 3 different age groups by using the Nationwide Inpatient Sample (NIS) database. methods The data were obtained from NIS from 2002 to 2011. Data on patients with closed fractures of C-2 without spinal cord injury were extracted using ICD-9-CM diagnosis code 805.02. Patients with isolated C-2 fractures were identified by excluding patients with other associated injuries. The cohort was divided into 3 age groups: &lt; 65 years, 65\u201380 years, and &gt; 80 years. Incidence, treatment characteristics, inpatient\/postoperative complications, and hospital charges (mean and total annual charges) were compared between the 3 age groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 10,336 patients with isolated C-2 fractures were identified. The majority of the patients were in the very elderly age group (&gt; 80 years; 42.3%) followed by 29.7% in the 65- to 80-year age group and 28% in &lt; 65-year age group. From 2002 to 2011, the incidence of hospitalization significantly increased in the 65- to 80-year and &gt; 80-year age groups (p &lt; 0.001). However, the incidence did not change substantially in the &lt; 65-year age group (p = 0.287). Overall, 21% of the patients were treated surgically, and 12.2% of the patients underwent nonoperative interventions (halo and spinal traction). The rate of nonoperative interventions significantly decreased over time in all age groups (p &lt; 0.001). Regardless of treatment given, patients in older age groups had a greater risk of inpatient\/postoperative complications, nonroutine discharges, and longer hospitalization. The mean hospital charges were significantly higher in older age groups (p &lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The incidence of hospitalization for isolated C-2 fractures is progressively increasing in older age groups. Simultaneously, there has been a steadily decreasing trend in the preference for nonoperative interventions. Due to more complicated hospital stay, longer hospitalizations, and higher rates of nonroutine discharges, the patients in older age groups seem to have a higher propensity for greater health care resource utilization.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2015.1.focus14825","type":"journal-article","created":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T13:05:25Z","timestamp":1427893525000},"page":"E19","source":"Crossref","is-referenced-by-count":15,"title":["National trends of incidence, treatment, and hospital charges of isolated C-2 fractures in three different age groups"],"prefix":"10.3171","volume":"38","author":[{"given":"Sunil","family":"Kukreja","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piyush","family":"Kalakoti","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Murray","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menarvia","family":"Nixon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Symeon","family":"Missios","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bharat","family":"Guthikonda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anil","family":"Nanda","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Louisiana State University Health Sciences Center-Shreveport, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus14825","series-title":"Healthcare Cost and Utilization Project.","author":"Agency for Healthcare Research","year":"2015"},{"key":"b2-focus14825","series-title":"Dysphagia","first-page":"156","article-title":"Severe dysphagia secondary to posterior C1-C3 instrumentation in a patient with atlantoaxial traumatic injury: a case report and review of the literature","volume":"25","author":"Bekelis","year":"2010"},{"key":"b3-focus14825","series-title":"Spine (Phila Pa 1976)","first-page":"854","article-title":"Impact of age, injury severity score, and medical comorbidities on early complications after fusion and halo-vest immobilization for C2 fractures in older adults: a propensity score matched retrospective cohort study","volume":"37","author":"Boakye","year":"2012"},{"key":"b4-focus14825","series-title":"Clin Orthop Relat Res","first-page":"201","article-title":"Is administratively coded comorbidity and complication data in total joint arthroplasty valid?","volume":"471","author":"Bozic","year":"2013"},{"key":"b5-focus14825","series-title":"J Neurosurg Spine","first-page":"16","article-title":"Comparison of ICD-9-based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting","volume":"14","author":"Campbell","year":"2011"},{"key":"b6-focus14825","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b7-focus14825","series-title":"J Bone Joint Surg Am","first-page":"1340","article-title":"Fractures of the dens. A multicenter study","volume":"67","author":"Clark","year":"1985"},{"key":"b8-focus14825","series-title":"Census Briefs. United States Census Bureau","article-title":"The Hispanic population: 2010. 2010","author":"Ennis","year":"2015"},{"key":"b9-focus14825","series-title":"J Trauma","first-page":"583","article-title":"Odontoid fractures in the elderly: should we operate?","volume":"68","author":"Fagin","year":"2010"},{"key":"b10-focus14825","series-title":"Spine (Phila Pa 1976)","first-page":"1584","article-title":"Incidence and risk factors for gastrointestinal hemorrhage after lumbar fusion","volume":"38","author":"Fineberg","year":"2013"},{"key":"b11-focus14825","series-title":"Neurosurgery","first-page":"292","article-title":"Revision surgery for cervical spondylotic myelopathy: surgical results and outcome","volume":"63","author":"Gok","year":"2008"},{"issue":"3 Suppl","key":"b12-focus14825","series-title":"Neurosurgery","first-page":"S1","article-title":"Guidelines for management of acute cervical spinal injuries. 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Trauma","first-page":"199","article-title":"Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures","volume":"60","author":"Tashjian","year":"2006"},{"issue":"3 Suppl Operative","key":"b34-focus14825","series-title":"Neurosurgery","first-page":"ons229","article-title":"Anterior fixation of the axis","volume":"67","author":"Traynelis","year":"2010"},{"key":"b35-focus14825","series-title":"World Population Ageing 2013","author":"United Nations Department of Economic and Social Affairs","year":"2013"},{"key":"b36-focus14825","series-title":"J Orthop Sci","first-page":"485","article-title":"Upper cervical spine injuries: age-specific clinical features","volume":"15","author":"Watanabe","year":"2010"},{"key":"b37-focus14825","series-title":"Spine (Phila Pa 1976)","first-page":"752","article-title":"Incidence of second cervical vertebral fractures far surpassed the rate predicted by the changing age distribution and growth among elderly persons in the 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comorbidity and complication data in total joint arthroplasty valid?","volume":"471","author":"Bozic","year":"2013"},{"key":"b5-focus14825","series-title":"J Neurosurg Spine","first-page":"16","article-title":"Comparison of ICD-9-based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting","volume":"14","author":"Campbell","year":"2011"},{"key":"b6-focus14825","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b7-focus14825","series-title":"J Bone Joint Surg Am","first-page":"1340","article-title":"Fractures of the dens. A multicenter study","volume":"67","author":"Clark","year":"1985"},{"key":"b8-focus14825","series-title":"Census Briefs. United States Census Bureau","article-title":"The Hispanic population: 2010. 2010","author":"Ennis","year":"2015"},{"key":"b9-focus14825","series-title":"J Trauma","first-page":"583","article-title":"Odontoid fractures in the elderly: should we operate?","volume":"68","author":"Fagin","year":"2010"},{"key":"b10-focus14825","series-title":"Spine (Phila Pa 1976)","first-page":"1584","article-title":"Incidence and risk factors for gastrointestinal hemorrhage after lumbar fusion","volume":"38","author":"Fineberg","year":"2013"},{"key":"b11-focus14825","series-title":"Neurosurgery","first-page":"292","article-title":"Revision surgery for cervical spondylotic myelopathy: surgical results and outcome","volume":"63","author":"Gok","year":"2008"},{"issue":"3 Suppl","key":"b12-focus14825","series-title":"Neurosurgery","first-page":"S1","article-title":"Guidelines for management of acute cervical spinal injuries. Introduction","volume":"50","year":"2002"},{"issue":"5 Pt 1","key":"b13-focus14825","series-title":"J Neurosurg","first-page":"642","article-title":"Acute axis fractures: a review of 229 cases","volume":"71","author":"Hadley","year":"1989"},{"key":"b14-focus14825","series-title":"Clin Neurosurg","first-page":"407","article-title":"Guidelines for the management of acute cervical spine and spinal cord injuries","volume":"49","author":"Hadley","year":"2002"},{"key":"b15-focus14825","series-title":"global Spine J","first-page":"37","article-title":"Craniocervical traumatic injuries: evaluation and surgical decision making","volume":"1","author":"Joaquim","year":"2011"},{"key":"b16-focus14825","series-title":"Semin Spine Surg","first-page":"23","article-title":"Fractures of the C1 and C2 vertebrae","volume":"25","author":"Kalantar","year":"2013"},{"key":"b17-focus14825","series-title":"J Gerontol A Biol Sci Med Sci","first-page":"180","article-title":"Alarming rise in the number and incidence of fall-induced cervical spine injuries among older adults","volume":"62","author":"Kannus","year":"2007"},{"issue":"6","key":"b18-focus14825","series-title":"Neurosurg Focus","first-page":"E7","article-title":"Type II odontoid fractures in the elderly: early failure of nonsurgical treatment","volume":"8","author":"Kuntz","year":"2000"},{"key":"b19-focus14825","series-title":"J Trauma","first-page":"1908","article-title":"Severely injured geriatric population: morbidity, mortality, and risk factors","volume":"71","author":"Labib","year":"2011"},{"key":"b20-focus14825","series-title":"Med Care","first-page":"785","article-title":"Identification of in-hospital complications from claims data. Is it valid?","volume":"38","author":"Lawthers","year":"2000"},{"key":"b21-focus14825","series-title":"Spine (Phila Pa 1976)","first-page":"1234","article-title":"Management of type II dens fractures: a case-control study","volume":"25","author":"Lennarson","year":"2000"},{"key":"b22-focus14825","series-title":"AJR Am J Roentgenol","first-page":"573","article-title":"Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries","volume":"178","author":"Lomoschitz","year":"2002"},{"key":"b23-focus14825","series-title":"J Trauma","first-page":"350","article-title":"Halo vest immobilization in the elderly: a death sentence?","volume":"59","author":"Majercik","year":"2005"},{"key":"b24-focus14825","series-title":"Eur Spine J","first-page":"585","article-title":"Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients","volume":"17","author":"Malik","year":"2008"},{"key":"b25-focus14825","series-title":"Eur Spine J","first-page":"360","article-title":"Management of odontoid fractures in the elderly","volume":"8","author":"M\u00fcller","year":"1999"},{"key":"b26-focus14825","series-title":"Acta Orthop Scand","first-page":"175","article-title":"Accidental falls and related fractures in 65-74 year olds: a retrospective study of 332 patients","volume":"71","author":"Nordell","year":"2000"},{"key":"b27-focus14825","series-title":"Clin Orthop Relat Res","first-page":"178","article-title":"Odontoid fractures, with special reference to the elderly patient","volume":"(193)","author":"Pepin","year":"1985"},{"key":"b28-focus14825","series-title":"Neurosurgery","first-page":"450","article-title":"Nonoperative management of Types II and III odontoid fractures: the Philadelphia collar versus the halo 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