Cervical Spine Injuries in Patients 65 and Older

Spivak, Jeffrey M.; Weiss, Mitchell A.; Cotler, Jerome M.; Call, Mary Emily

doi:10.1097/00007632-199410150-00009

Cited by 138 publications

(82 citation statements)

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“…Forty-eight per cent sustained lower cervical spine injuries and 41% injured upper cervical spine (Table 2). Thus our review demonstrated a higher proportion of lower cervical spine injuries than upper cervical spine injuries in the elderly population, which is inconsistent with many other series reporting upper cervical injuries in majority of patients [7,13,18] Neurological injury associated with cervical trauma is less common in elderly patients, due to the higher incidence of odontoid injuries and the more minor nature of the trauma [16]. When a neurological injury does occur in the elderly, it is more commonly incomplete.…”

Section: Discussioncontrasting

confidence: 87%

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

et al. 2008

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We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient enquiry system, chart and radiographic review. Mean age was 74 years (range 66-93 years). The male to female ratio was 2.1:1 (M = 72, F = 35). The mean follow-up was 4.4 years (1-9 years) and mean in-hospital stay was 10 days (2-90 days). The mechanism of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in 44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2 dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology, 27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67 cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit at time of injury. Outcome of the injury was related to increasing age, co-morbidity and the severity of neurological deficit. Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis but unstable injuries require rigid external immobilization or surgical stabilization.

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Section: Discussioncontrasting

confidence: 87%

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

et al. 2008

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“…In the sampled population, the clinical pictures were not quite the same as previous reports. 4,8,10 First, the ratio of male patients was similar in both younger and older groups (87% vs 85%). In contrast, most other researchers reported a predominance of females in the elderly.…”

Section: Discussionmentioning

confidence: 87%

“…7,8 Other researchers reported a high proportion of odontoid fracture in the elderly with cervical injuries. 10,12 The strategy for prevention and care for the growing number of elderly people with SCI is thus becoming more important.…”

Section: Introductionmentioning

confidence: 99%

Impact of age on the injury pattern and survival of people with cervical cord injuries

et al. 2001

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Study design: A retrospective, follow-up study. Objectives: To di erentiate the injury pattern and survival of people with cervical cord injuries with onset at di erent ages. Setting: Rehabilitation wards of a university hospital that is a tertiary referral center in Taipei, Taiwan. Methods: The records of acute and traumatic cervical cord injury patients hospitalized from 1989 to 1997 were reviewed. All subjects received comprehensive rehabilitation programs during hospitalization. Their survival status at the end of follow-up was studied. Results: Forty-seven of 109 (43.1%) people with cervical cord injuries were 50 years or older at onset. Older patients were more frequently injured by minor falls, resulting in more incomplete quadriplegia. They also showed fewer spinal fractures, and more demonstrated associated spondylosis and ossi®cation of the posterior longitudinal ligament. Eleven (10.2%) subjects were deceased, found by a linkage to a death registration database at the end of follow-up. The signi®cant predictor of survival status at follow-up was older age at injury using Cox proportional hazards model. Conclusion: Spinal cord injured patients had di erent injury patterns, demanding di erent preventative strategies. Those injured at older ages were at higher risk of mortality according to our study.

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“…Type II odontoid fractures are the most common fractures of the cervical spine in the elderly [11,29,32,44]. Published literature on the radiological outcome in geriatric patients with type II odontoid fractures is scarce.…”

Section: Discussionmentioning

confidence: 99%

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

et al. 2011

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Introduction Type II odontoid fractures are one among the most common cervical spine fractures in the elders. We reviewed a consecutive series of patients, aged 65 years and older, presenting to our institution with type II odontoid fractures. Our analysis focused on the radiographic outcome, union rate and the development of cervical spine postural deformity. Patients/methods Indications for surgical treatment (OP) included displaced or unstable injuries. Stable, nondisplaced injuries or patients with significant co-morbidities were treated nonoperatively (non-op). Results Ninety patients (50 f, 40 m) with an average age of 83 years (65-101) were identified. 31 (34.4%) patients were received OP and 57 (63.3%) were received non-op treatments. The hospital length of stay was significantly longer after OP (mean 10 days vs. 6 days non-op) treatment (p = 0.007). At follow-up, higher union rates were noted in the OP (76.2%) than in the non-op group (58.3%). Conclusion We observed a characteristic cervical spine deformity in geriatric patients with type II odontoid fractures, and have termed this the ''Geier-deformity''. Clinical findings of the deformity include sagittal imbalance and kyphosis of the lower cervical spine.

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Cervical Spine Injuries in Patients 65 and Older

Cited by 138 publications

References 0 publications

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients

Impact of age on the injury pattern and survival of people with cervical cord injuries

Radiographic analysis of type II odontoid fractures in a geriatric patient population: description and pathomechanism of the “Geier”-deformity

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