Morbidity and mortality in cervical spine injuries in the elderly

Abstract

Background: The aim of our study was to identify the demographics and complications in elderly cervical spine injuries and predictive factors for surgery, complications and mortality. We hypothesized younger healthier patients were more likely to undergo surgical intervention. Methods: A retrospective review of 225 consecutive patients aged 65 years and over with cervical spine injuries was carried out over a 3-year period. Results: There were 113 males and 112 females with an average of 79.7 years (range 65-98). The most common fracture was C2 peg type (21.8%). Five patients had complete spinal cord injury (2.2%), 25 had incomplete spinal cord injury (11.1%) and 84% were neurologically intact. Fifty-four patients were managed operatively (24%), while 171 patients were managed non-operatively (76%). The operative group had higher rates of pneumonia (odds ratio (OR) 5.3, 95% confidence interval (CI) 2.6-10.7, P < 0.01), cardiac arrhythmia (OR 4.1, 95% CI 1.5-11.2, P < 0.01) and respiratory failure (OR 2.6, 95% CI 1.2-5.5, P < 0.05). There was no difference in mortality between the operative and non-operative group (18.5% and 12.9%, P = 0.3). Patients with complete spinal cord injury had 100% mortality. Significant predictive factors for complications and death were neurological deficits, comorbidities and the presence of other injuries (P < 0.05). Surgery was not predictive for death and the operative group was younger than the non-operative group (P < 0.05). Conclusions: In the setting of a high complication rate, consideration should be given to palliation in elderly patients with complete spinal cord injury and there must be good rational for surgery.

In-Hospital Mortality for the Elderly with Acute Traumatic Spinal Cord Injury

“…This is consistent with the findings by Martin and coworkers, 20 who described an ''inflection point'' at the age of 75 for in-hospital mortality following cervical SCI. Our overall in-hospital mortality rate of 16% is slightly lower than the 12-40% reported by others, [15][16][17][18][19][20] but our data may underestimate the rate, as some patients who died shortly after admission may not have been enrolled in the registry.…”

“…14 A tSCI is both a devastating physiological and psychological insult for all patients, particularly in the elderly who often have multiple pre-existing comorbidities. In-hospital mortality rates in elderly patients with tSCI are reported as being 12-40%, [15][16][17][18][19][20] considerably higher than the estimated mortality of <5% in younger patient populations. 16 Previously identified risk factors for mortality in the elderly include older age, higher cervical level of injury, neurological severity, and increasing number of comorbidities; 17,18,20 however, to our knowledge, no one has developed a clinical decision-making aid using a combination of these factors for in-hospital mortality for this elderly population.…”

“…27 Few studies focus on in-hospital mortality of the elderly population, with fewer comparing this outcome following surgical and non-surgical interventions. 17,19 Further, most studies compare the elderly with a younger population 13,15,16,20 or involve only cervical SCI or spine fractures. 15,17,19,20,[28][29][30] Further understanding on the clinical course of elderly patients with tSCI and the specific risk factors for those who die despite aggressive surgical management will inform early communication and shared decision making between clinicians and patients and family.…”

Predictors of 30-Day Unplanned Readmissions, Complications, and Mortality Following Operative Management of C2 Fractures

“…We found a number of factors associated with increased complication risk that is consistent with prior reports in the literature. In a retrospective review of 225 consecutive patients, Bokhari et al 21 found that neurological deficits, comorbidities, and presence of other injuries were predictors of complications and death. Similarly, we also found that the presence of at least one comorbidity increased the odds of having at least one complication.…”

Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

“…Injuries to the upper cervical spine represent a serious entity including a wide spectrum of pathology ranging from benign to life threatening [1]. Especially in the elderly, these injuries are not uncommon and their incidence will continue to grow due to increasing life expectancy and higher activity levels of the elderly population [5][6][7][8][9]. Currently, the emphasis centers on surgical treatment to obtain good alignment and stability to allow early mobilization.…”