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.
Department of Genetics and Development, Toronto Western Research Institute, University Health Network, Toronto, Ontario, Canada M5T 2S8.
Julio C
JC
Furlan
Michael B
MB
Bracken
Michael G
MG
Fehlings
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