Long-term clinical outcomes following surgical management of cervical spine fractures in elderly patients

Objective: To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age. Summary and Background Data: Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly who constitute an increasing percentage of the US population. Methods: We analyzed data collected for 10 years at a state-designated level I trauma center to identify variables that influenced in-hospital and long-term mortality among elderly patients with traumatic cervical spine fracture with or without SCI. Acute in-hospital mortality was determined from hospital records and long-term mortality within the study period (2003-2013) was determined from the National Death Index. Univariate and multivariate regression analyses were used to identify factors influencing survival. Results: Data from patients (N = 632) with cervical spine fractures were analyzed, the majority (66%) of whom were geriatric (older than age 64). Most patients (62%) had a mild/moderate injury severity score (ISS; median, interquartile range: 6, 5). Patients with SCI had significantly longer lengths of stay (14.1 days), days on a ventilator (3.5 days), and higher ISS (14.9) than patients without SCI ( P < .0001 for all). Falls were the leading mechanism of injury for patients older than age 64. Univariate analysis identified that long-term survival decreased significantly for all patients older than age 65 (hazard ratio [HR]: 1.07; P < .0001). Multivariate analysis demonstrated age (HR: 1.08; P < .0001), gender (HR: 1.60; P < .0007), and SCI status (HR: 1.45, P < .02) significantly influenced survival during the study period. Conclusion: This study identified age, gender, and SCI status as significant variables for this study population influencing long-term survival among patients with cervical spine fractures. Our results support the growing notion that cervical spine injuries in geriatric patients with trauma may warrant additional research.

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Complications and long-term outcomes after open surgery for traumatic subaxial cervical spine fractures: a consecutive series of 303 patients

BMC Surgery ◽

10.1186/s12893-016-0172-z ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 7

Author(s):

Hege Linnerud Fredø ◽

Syed Ali Mujtaba Rizvi ◽

Mehran Rezai ◽

Pål Rønning ◽

Bjarne Lied ◽

...

Keyword(s):

Cervical Spine ◽

Open Surgery ◽

Consecutive Series ◽

Spine Fractures ◽

Long Term Outcomes ◽

Subaxial Cervical Spine ◽

Cervical Spine Fractures

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A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis

Neurosurgical FOCUS ◽

10.3171/foc/2008/24/1/e11 ◽

2008 ◽

Vol 24 (1) ◽

pp. E11 ◽

Cited By ~ 32

Author(s):

Adam S. Kanter ◽

Michael Y. Wang ◽

Praveen V. Mummaneni

Keyword(s):

Cervical Spine ◽

Ankylosing Spondylitis ◽

Problem Solving ◽

Surgical Management ◽

Treatment Algorithm ◽

Clinical Problem ◽

Spine Fractures ◽

Clinical Problem Solving ◽

Bone Fusion ◽

Cervical Spine Fractures

Object Patients with ankylosing spondylitis (AS) who present with cervical spine fractures represent a unique challenge to spine surgeons. These injuries often result in neurological deficits that necessitate early and aggressive surgical management with posterior and/or anterior fixation. The authors introduce a clinical problem-solving algorithm to assist in the surgical management of instability and deformity in this exigent patient population. Methods Thirteen patients with AS and fractures of the cervical spine were radiographically evaluated to determine if spinal realignment was obtainable with cervical manipulation or traction. Seven patients had flexible deformities that were stabilized with either anterior or posterior fixation only, and 6 patients had fixed deformities and required circumferential anterior–posterior instrumentation. All patients were observed for neurological outcome, radiographic evidence of bone fusion, and complications. Results With the use of the authors' treatment algorithm, all patients were able to achieve satisfactory spinal realignment and bone fusion; 92% of patients achieved postoperative stability or improvement in Nurick and modified Japanese Orthopaedic Association scale scores. One patient experienced neurological deterioration following surgery, and 1 patient died at an acute rehabilitative facility following discharge. Conclusions Patients with AS are highly susceptible to extensive neurological injury and spinal deformity after sustaining cervical fractures from even minor traumatic forces. These injuries are uniquely complex in nature and require considerable scrutiny and aggressive surgical management to optimize spinal stability and functional outcomes. The authors' clinical problem-solving algorithm will assist spine surgeons in providing optimal care in this difficult population.

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