Acute outcomes of cervical spine injuries in the elderly: atlantaxial vs subaxial injuries.

BACKGROUND/OBJECTIVE: Recent studies have reported on the outcomes of spinal cord injuries in the elderly. Our aim was to identify acute survival differences between elderly patients with atlantoaxial injuries relative to subaxial injuries at our institution and to determine whether operative treatment is associated with improved survival rates in either population.

STUDY DESIGN

Retrospective database review of all traumatic cervical spine injuries in patients at least 65 years of age at a single tertiary care center.

METHODS

A total of 193 consecutive patients at least 65 years of age treated at a single tertiary care center over a 12-year period were identified. Initial hospitalization records were reviewed. Patients were divided by anatomic level of injury: atlantoaxial (C1 or C2) and subaxial (C3 or below). Demographics, mechanism, and mortality rates were compared. Each group was further divided by treatment (operative or nonoperative), and inpatient survival rates were compared.

RESULTS

Statistically similar survival rates were observed among patients with atlantoaxial and subaxial injuries (P = 0.10). Patients with nonoperatively treated subaxial injuries died at significantly higher rates than did their operatively treated peers (P < 0.05).

CONCLUSIONS

In this large comprehensive series of elderly patients with cervical spine injuries, survival rates were comparable regardless of anatomic level of injury. The operative treatment of subaxial injuries was associated with an improved acute survival rate vs nonoperative management. Further prospective study is needed to better assess this relationship.