Upper cervical spine trauma is frequent in elderly patients. The mechanism of injury is usually a low energy trauma, which explains the delay in diagnosis of this serious injury. There is no consensus on patient management. Both conservative and surgical management are associated with morbidity and mortality, although the risk factors have not been statistically confirmed by publications in the literature. Conservative treatment with a neck brace or a halo vest should be limited to stable fractures. Any instability should be treated with surgery. In these elderly patients surgery seems to result in a better rate of union, faster return to the same level of autonomy as before the injury, as well as in lower mortality than in non-surgical patients. Prospective descriptive studies are needed so that guidelines can be drafted for the management of this frequent, complex and sometimes life-threatening entity.
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