Odontoid fractures are considered a frequent pathology within elderly patients in relationship with degenerative bone changes in context of aging. Its management depends on the type of fracture according to Anderson and D’Alonzo classification. Type I and III fractures are susceptible of conservative management due to its high fusion rate. Treatment of type II fractures is controversial due to its high mortality and morbidity rates associated with the type of patients affected. We present the case of an octogenarian patient with a C1-C2 anterior spinal epidural hematoma due to type II odontoid fracture managed with urgent odontoidectomy and hematoma removal.