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. 2024 Jun;14(5):1583-1594.
doi: 10.1177/21925682231151643. Epub 2023 Jan 13.

Epidemiology of Cervical Fracture/Cervical Spinal Cord Injury and Changes in Surgical Treatment Modalities in Elderly Individuals During a 10-year Period: A Nationwide Multicenter Study in Japan

Naoki Segi  1 , Hiroaki Nakashima  1 , Masaaki Machino  1 , Sadayuki Ito  1 , Noriaki Yokogawa  2 , Takeshi Sasagawa  2   3 , Toru Funayama  4 , Fumihiko Eto  5 , Kota Watanabe  6 , Satoshi Nori  6 , Takeo Furuya  7 , Atsushi Yunde  7 , Hideaki Nakajima  8 , Tomohiko Hasegawa  9 , Tomohiro Yamada  9   10 , Yoshinori Terashima  11   12 , Ryosuke Hirota  11 , Hidenori Suzuki  13 , Yasuaki Imajo  13 , Shota Ikegami  14 , Masashi Uehara  14 , Hitoshi Tonomura  15 , Munehiro Sakata  15   16 , Ko Hashimoto  17 , Yoshito Onoda  17 , Kenichi Kawaguchi  18 , Yohei Haruta  18 , Nobuyuki Suzuki  19 , Kenji Kato  19 , Hiroshi Uei  20   21 , Hirokatsu Sawada  21 , Kazuo Nakanishi  22 , Kosuke Misaki  22 , Hidetomi Terai  23 , Koji Tamai  23 , Gen Inoue  24 , Eiki Shirasawa  24 , Kenichiro Kakutani  25 , Yoichi Iizuka  26 , Eiji Takasawa  26 , Koji Akeda  27 , Katsuhito Kiyasu  28 , Hiroyuki Tominaga  29 , Hiroto Tokumoto  29 , Haruki Funao  30   31   32 , Yasushi Oshima  33 , Toshitaka Yoshii  34 , Takashi Kaito  35 , Daisuke Sakai  36 , Tetsuro Ohba  37 , Shoji Seki  38 , Bungo Otsuki  39 , Masayuki Ishihara  40 , Masashi Miyazaki  41 , Seiji Okada  35 , Shiro Imagama  1 , Satoshi Kato  2
Affiliations

Epidemiology of Cervical Fracture/Cervical Spinal Cord Injury and Changes in Surgical Treatment Modalities in Elderly Individuals During a 10-year Period: A Nationwide Multicenter Study in Japan

Naoki Segi et al. Global Spine J. 2024 Jun.

Abstract

Study design: Retrospective multicenter study.

Objectives: To investigate changes over a 10-years period in the profile of cervical spine and spinal cord injuries among the elderly in Japan.

Methods: The current multicenter study was a retrospective analysis of inpatients aged ≥65 years, suffering cervical fracture (CF) and/or cervical spinal cord injury (CSCI). We analyzed 1413 patients' epidemiology (from 2010 to 2019). Moreover, 727 patients who underwent surgical treatment were analyzed in 2 groups: the early (2010-2014) and late period (2015-2019).

Results: Both the number of patients and number of surgical patients showed a significant increasing trend (P < .001), while the mean age, the distribution of injury levels and paralysis severity, and the proportion of surgical indications remained the same. The number of surgical patients doubled from 228 to 499 from the early to late periods. Posterior surgery was the most common approach (90.4%), instrumentation surgery with screws increased significantly, and the range of fusion was significantly longer in the late period (2.1 vs 2.7 levels, P = .001). Significantly worsening neurological symptoms were recorded in the late period (1.3% vs 5.8%, P = .006), with C5 palsy being the major one. Otherwise, perioperative, major, and other complications, including mortality, did not differ significantly in incidence.

Conclusions: Both the number of elderly CF and/or CSCI patients and number of patients undergoing surgery increased dramatically over the decade without any change in profile. Instrumentation surgeries with screws increased, without an increase in systemic complications.

Keywords: cervical fracture; cervical spinal cord injury; elderly; instrumentation surgery; operative complication; surgical treatment modality.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flowchart of patient inclusion.
Figure 2.
Figure 2.
Epidemiological trends in all patients.
Figure 3.
Figure 3.
Surgical procedures according to the presence of fracture.
See this image and copyright information in PMC

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