Retrospective Cohort Study. To evaluate risk factors for adverse outcome and complications of elderly patients with upper cervical spine fracture following conservative or surgical treatment. 141 cases of elderly patients (≥ 65 years) admitted between 01/2013 and 12/2015 with upper cervical spine injuries were retrospectively analyzed through our prospectively collected database. Median follow-up was 113.5 days (IQR: 21–393). With a collective median age of 79, operatively treated patients (41