Is age a key determinant of mortality and neurological outcome after acute traumatic spinal cord injury?
Given the potential impact of age on mortality, neurological outcomes and the extent of post-traumatic neural degeneration, we examined these issues using a large, prospectively accrued clinical database (n=485) supplemented by analysis of postmortem spinal cord tissue (n=12) to compare axonal survival and white matter degeneration in younger versus elderly individuals with spinal cord injury (SCI). Elderly individuals (> or = 65 years) had significantly greater mortality rates than younger individuals at 30 days, at 6 months and at 1 year following SCI (46.88% versus 4.86%, respectively; p<0.0001). However, among survivors, age was not significantly associated with motor and sensory outcomes at 6 weeks, 6 months and 1 year post-SCI in univariate and multivariate analyses. Correspondingly, neuroanatomical analysis of postmortem spinal cord tissue revealed no significant age-related differences for extent of myelin degeneration or number of intact axons within sensory, motor and autonomic spinal cord tracts post-SCI. Treatment protocols for SCI need to identify preventable predictors of mortality in the elderly post-SCI, recognizing that the potential for neurological recovery among elderly survivors of SCI is similar to that of younger individuals.
Furlan
Julio C
JC
Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.
Bracken
Michael B
MB
Fehlings
Michael G
MG
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D019992:Databases as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D013116:Spinal Cord / Q000473:pathology*; D013119:Spinal Cord Injuries / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D020196:Trauma, Nervous System / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult