Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital, 1053 Carling Ave, Ottawa, Ontario, Canada K1Y 4E9.
Spine J. 2013 Aug;13(8):862-6. doi: 10.1016/j.spinee.2013.01.045. Epub 2013 Mar 1.
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.
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.
STUDY DESIGN/SETTING: Retrospective cohort study at two Level 1 trauma centers.
Thirty-seven consecutive patients aged 60 years and older who had SCIs related to C-spine fractures.
Level of injury, injury severity, preinjury medical comorbidities, treatment (operative vs. nonoperative), and cause of death.
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.
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.
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.
与颈椎（C 脊柱）骨折相关的脊髓损伤（SCI）可导致显著的发病率和死亡率。在老年人群中，管理与 C 脊柱骨折相关的不稳定需要积极治疗，但这种治疗既复杂又有危险。
确定与 C 脊柱骨折相关的老年 SCI 患者的死亡率，并确定导致不良预后的风险因素。
研究设计/设置：在两个 1 级创伤中心进行的回顾性队列研究。
37 例年龄在 60 岁及以上且与 C 脊柱骨折相关的 SCI 患者。
损伤水平、损伤严重程度、受伤前的医疗合并症、治疗（手术与非手术）和死亡原因。
对医院病历进行独立审查。对基线 X 线片和 CT 或 MRI 扫描进行检查，以根据 Allen 和 Ferguson 对下颈椎损伤的力学分类进行分类。进行单变量逻辑回归分析以确定与住院期间死亡率和出院时行走能力相关的因素。无资金来源或潜在利益冲突需要披露。
住院死亡率为 38%。呼吸衰竭是导致死亡的主要原因。受伤前的医疗合并症、年龄以及手术与非手术治疗均不影响死亡率。C4 及以上的损伤水平与 C4 以下损伤相比，死亡风险高 7.1 倍（p=.01）。完全性 SCI 与不完全性 SCI 相比，死亡风险高 5.1 倍（p=.03）。神经恢复不常见。除初始 SCI 的严重程度外，没有其他因素与出院时的步行能力有关。
在这个老年人群中，神经恢复情况不佳，住院死亡率较高。死亡的最强风险因素是损伤水平和 SCI 的严重程度。尽管每例与 C 脊柱骨折相关的 SCI 病例都不同，但医生可能能够利用这些发现来更好地确定预后并指导后续治疗。
