Evaluation of morbidity,mortality and outcome following cervical spine injuries in elderly patients |
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Authors: | S A Malik M Murphy P Connolly J O’Byrne |
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Institution: | (1) National Spinal Injury Unit, Mater Misericordiae Hospital, 59 Eccles Street, Dublin 2, Ireland |
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Abstract: | We analysed the morbidity, mortality and outcome of cervical spine injuries in patients over the age of 65 years. This study
was a retrospective review of 107 elderly patients admitted to our tertiary referral spinal injuries unit with cervical spine
injuries between 1994 and 2002. The data was acquired by analysis of the national spinal unit database, hospital inpatient
enquiry system, chart and radiographic review. Mean age was 74 years (range 66–93 years). The male to female ratio was 2.1:1
(M = 72, F = 35). The mean follow-up was 4.4 years (1–9 years) and mean in-hospital stay was 10 days (2–90 days). The mechanism
of injury was a fall in 75 and road traffic accident in the remaining 32 patients. The level involved was atlanto-axial in
44 cases, sub-axial in 52 cases and the remaining 11 had no bony injury. Multilevel involvement occurred in 48 patients. C2
dominated the single level injury and most of them were type II odontoid fractures. Four patients had complete neurology,
27 had incomplete neurology, and the remaining 76 had no neurological deficit. Treatment included cervical orthosis in 67
cases, halo immobilization in 25, posterior stabilization in 12 patients and anterior cervical fusion in three patients. The
overall complication rate was 18.6% with an associated in-hospital mortality of 11.2%. The complications included loss of
reduction due to halo and Minerva loosening, non-union and delayed union among conservatively treated patients, pin site and
wound infection, gastrointestinal bleeding and complication due to associated injuries. Among the 28.9% patients with neurological
involvement, 37.7% had significant neurological recovery. Outcome was assessed using a cervical spine outcome questionnaire
from Johns Hopkins School of Medicine. Sixty-seven patients (70%) completed the form, 20 patients (19%) were deceased at review
and 8 patients (7%) were uncontactable. Functional disability was more marked in the patients with neurologically deficit
at time of injury. Outcome of the injury was related to increasing age, co-morbidity and the severity of neurological deficit.
Injuries of the cervical spine are not infrequent occurrence in the elderly and occur with relatively minor trauma. Neck pain
in the elderly patients should be thoroughly evaluated to exclude C2 injuries. Most patients can be managed in an orthosis
but unstable injuries require rigid external immobilization or surgical stabilization. |
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Keywords: | Elderly Cervical spine injury External immobilization Outcome |
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