Differences in clinical characteristics of cervical spine injuries in older adults by external causes: a multicenter study of 1512 cases

Abstract

Although traumatic cervical spine injuries in older adults are commonly caused by minor traumas, such as ground-level falls, their prognosis is often unfavorable. Studies examining the clinical characteristics of cervical spine injuries in older adults according to the external cause of injury are lacking. This study included 1512 patients of ≥ 65 years of age with traumatic cervical spine injuries registered in a Japanese nationwide multicenter database. The relationship between the external causes and clinical characteristics, as well as factors causing unfavorable outcomes at the ground-level falls, were retrospectively reviewed and examined. When fall-induced cervical spine injuries were categorized and compared based on fall height, the patients’ backgrounds and injury statuses differed significantly. Of note, patients injured from ground-level falls tended to have poorer pre-injury health conditions, such as medical comorbidities and frailty, compared with those who fell from higher heights. For ground-level falls, the mortality, walking independence, and home-discharge rates at 6 months post-injury were 9%, 67%, and 80%, respectively, with preexisting medical comorbidities and frailty associated with unfavorable outcomes, independent of age or severity of neurological impairment at the time of injury.

Blunt Cerebrovascular Injury in the Elderly With Traumatic Cervical Spine Injuries: Results of a Retrospective Multi-Center Study of 1512 Cases in Japan

“…Our data showed that 304 (20%) of the 1512 patients 65 years or older with SCI had no major bone injury and that SCI in 20% of the patients was caused by low-energy trauma. 16 , 17 Therefore, we think that the occurrence rate of 3.5% in the elderly patients was lower than that typically seen in young and adult patients. Previous articles have not reported the risk factors based on AO classifications.…”

“…In total, 1512 patients from 33 nationwide institutions were enrolled in this study (average age: 75.8 ± 6.9 years; 1007 males, 505 females). 16 , 17 Data including age at injury, sex, height and weight at first visit, past/present cigarette smoking, spinal surgery for the CSI, and comorbidities (hypertension, cerebrovascular disease, cardiovascular disease, ossification of posterior longitudinal ligament [OPLL] and head injury) were collected. Characteristics of the study population are shown in Table 1 .…”

“…Although this multi-center large cohort study is retrospective in nature, we evaluated the largest number of older individuals (aged ≥65 years) with CSI with BCVI; therefore, we provide stronger evidence than previous reports in elderly BCVI with CSI in this study. 16 …”

“…Therefore, the purposes of our study were to determine the incidence of BCVI and real clinical outcomes in elderly Japanese people following BCVI caused by CSI not defined by the newly classified high-risk patterns of injury through analysis of elderly CSI patients in a large nationwide database and to clarify the characteristics of risk factors of BCVI that lead to severe complications including mortality and brain infarction in these patients. 6 , 7 , 16 …”

Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries—A Multicenter Retrospective Study of 1512 Cases

“…Patients whose treatment course and outcome were unclear were excluded. Data collection was performed using the multicenter database of the Japan Association of Spine Surgeons with Ambition [ 21 ]. Traumatic cervical spine injuries included (1) isolated cervical fractures and/or dislocations, (2) isolated spinal cord injury, and (3) spinal cord injury with fractures and/or dislocations.…”