Isolated Cervical Spine Fractures in the Elderly: A Deadly Injury

Abstract

Traumatic injury in the elderly is an increasing problem and studies have shown that elderly patients (>/=65 years old) with cervical spine fractures and spinal cord injury (SCI) carry a mortality rate of 21% to 30%. However, little has been described with regard to outcomes for elderly patients with isolated cervical spine fractures (ICSF). Outcomes for elderly patients with ICSF will be similar to elderly patients with cervical fractures and associated traumatic injuries (ATI) or SCI. A 9-year retrospective analysis was performed on all patients >/=65 years old admitted to a level I trauma center with any cervical spine fracture. Primary outcomes were defined as favorable (discharge to home or rehabilitation hospital) or unfavorable (death, discharge to a long-term acute care facility, or a skilled nursing facility). ICSF was defined as those fractures without ATI or SCI. Long-term mortality data were gathered using the Social Security Death Index. A total of 177 patients with mean age of 78 +/- 1 and Injury Severity Score of 17 +/- 1 were evaluated. Fifty-six percent were men and falls were the most common mechanism (62%). An unfavorable outcome was seen in 56% of the study population with a mortality rate of 25%. ATIs were seen in 57% of the population and 22% had SCI. Patients with SCI had a significantly higher mortality compared with patients without SCI (38% vs. 22%, p = 0.032). However, there was no difference in unfavorable outcomes. Patients with ICSF had no differences in unfavorable outcomes compared with patients with SCI or ATI. Long-term survival analysis after discharge (mean = 2.8 years) demonstrated that patients with a favorable outcome had a significantly improved survival compared with patients with unfavorable outcomes (p < 0.001). ICSFs were associated with an unfavorable outcome in the elderly population regardless of ATI or SCI. These unfavorable outcomes were also associated with long-term mortality. Strategies to reduce morbidity and mortality in this devastating injury will be essential to improve outcomes and maximize resource utilization.