title: Spinal cord injuries related to cervical spine fractures in elderly patients: factors affecting mortality.
abstract: BACKGROUND
  Spinal cord injuries (SCIs) related to cervical spine (C-spine) fractures can cause significant morbidity and mortality. Aggressive treatment often required to manage instability associated with C-spine fractures is complicated and hazardous in the elderly population.
  
  
  OBJECTIVE
  To determine the mortality rate of elderly patients with SCIs related to C-spine fractures and identify factors that contribute toward a higher risk for negative outcomes.
  
  
  METHODS
  Retrospective cohort study at two Level 1 trauma centers.
  
  
  METHODS
  Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures.
  
  
  METHODS
  Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death.
  
  
  METHODS
  Hospital medical records were reviewed independently. Baseline radiographs and computed tomography or magnetic resonance imaging scans were examined to permit categorization according to the mechanistic classification by Allen and Ferguson of subaxial C-spine injuries. Univariate logistic regression analyses were performed to identify factors related to in-hospital mortality and ambulation at discharge. There were no funding sources or potential conflicts of interest to disclose.
  
  
  RESULTS
  The in-hospital mortality rate was 38%. Respiratory failure was the leading cause of death. Preinjury medical comorbidities, age, and operative versus nonoperative treatment did not affect mortality. Injury level at or above C4 was associated with a 7.1 times higher risk of mortality compared with injuries below C4 (p=.01). Complete SCI was associated with a 5.1 times higher risk of mortality compared with incomplete SCI (p=.03). Neurological recovery was uncommon. Apart from severity of initial SCI, no other factor was related to ambulatory disposition at discharge.
  
  
  CONCLUSIONS
  In this elderly population, neurological recovery was poor and the in-hospital mortality rate was high. The strongest risk factors for mortality were injury level and severity of SCI. Although each case of SCI related to C-spine fractures is different, physicians may be able to use these findings to help better determine the prognosis and guide subsequent treatment.
authors: Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
authors: Parham
authors: P
authors: Daneshvar
authors: Darren M
authors: DM
authors: Roffey
authors: Yasser A
authors: YA
authors: Brikeet
authors: Eve C
authors: EC
authors: Tsai
authors: Chris S
authors: CS
authors: Bailey
authors: Eugene K
authors: EK
authors: Wai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002574:Cervical Vertebrae / Q000293:injuries*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016103:Spinal Fractures / Q000150:complications / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Cervical; Fracture; Mortality; Prognosis; Spinal cord injury