. 2024 Apr 3;8(6):560-567.

doi: 10.22603/ssrr.2024-0030. eCollection 2024 Nov 27.

Comparative Analysis of Characteristics of Lower- and Mid-Cervical Spine Injuries in the Elderly

Naoki Segi¹, Hiroaki Nakashima¹, Sadayuki Ito¹, Jun Ouchida¹, Noriaki Yokogawa², Takeshi Sasagawa^{2

3}, Takeo Furuya⁴, Atsushi Yunde⁴, Toru Funayama⁵, Fumihiko Eto⁶, Kota Watanabe⁷, Satoshi Nori⁷, Shota Ikegami⁸, Masashi Uehara⁸, Ko Hashimoto⁹, Yoshito Onoda⁹, Hideaki Nakajima¹⁰, Hidenori Suzuki¹¹, Yasuaki Imajo¹¹, Tomohiro Yamada^{12

13}, Tomohiko Hasegawa¹², Kenichi Kawaguchi¹⁴, Yohei Haruta¹⁴, Yoshinori Terashima^{15

16}, Ryosuke Hirota¹⁵, Hitoshi Tonomura¹⁷, Munehiro Sakata^{17

18}, Yoichi Iizuka¹⁹, Hiroshi Uei^{20

21}, Nobuyuki Suzuki²², Koji Akeda²³, Hiroyuki Tominaga²⁴, Shoji Seki²⁵, Yasushi Oshima²⁶, Takashi Kaito²⁷, Bungo Otsuki²⁸, Kazuo Nakanishi²⁹, Kenichiro Kakutani³⁰, Haruki Funao^{31

32

33}, Toshitaka Yoshii³⁴, Daisuke Sakai³⁵, Tetsuro Ohba³⁶, Masashi Miyazaki³⁷, Hidetomi Terai³⁸, Gen Inoue³⁹, Seiji Okada²⁷, Shiro Imagama¹, Satoshi Kato²

Affiliations

¹ Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
³ Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan.
⁴ Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁵ Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁶ Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
⁷ Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
⁹ Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁰ Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Matsuoka Shimoaizuki, Yoshida, Japan.
¹¹ Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
¹² Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
¹³ Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan.
¹⁴ Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁵ Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.
¹⁶ Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo, Japan.
¹⁷ Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁸ Department of Orthopaedics, Saiseikai Shiga Hospital, Ritto, Japan.
¹⁹ Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan.
²⁰ Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.
²¹ Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan.
²² Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
²³ Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
²⁴ Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
²⁵ Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
²⁶ Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
²⁷ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
²⁸ Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
²⁹ Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Kurashiki, Japan.
³⁰ Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
³¹ Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan.
³² Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan.
³³ Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
³⁴ Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
³⁵ Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.
³⁶ Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Japan.
³⁷ Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan.
³⁸ Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
³⁹ Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.

PMID: 39659382
PMCID: PMC11625708
DOI: 10.22603/ssrr.2024-0030

Comparative Analysis of Characteristics of Lower- and Mid-Cervical Spine Injuries in the Elderly

Naoki Segi et al. Spine Surg Relat Res. 2024.

. 2024 Apr 3;8(6):560-567.

doi: 10.22603/ssrr.2024-0030. eCollection 2024 Nov 27.

Authors

Affiliations

¹ Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
² Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
³ Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan.
⁴ Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
⁵ Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
⁶ Department of Orthopaedic Surgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan.
⁷ Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
⁹ Department of Orthopaedic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁰ Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences University of Fukui, Matsuoka Shimoaizuki, Yoshida, Japan.
¹¹ Department of Orthopaedic Surgery, Yamaguchi University Graduate School of Medicine, Ube, Japan.
¹² Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
¹³ Department of Orthopaedic Surgery, Nagoya Kyoritsu Hospital, Nagoya, Japan.
¹⁴ Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
¹⁵ Department of Orthopaedic Surgery, Sapporo Medical University, Sapporo, Japan.
¹⁶ Department of Orthopaedic Surgery, Matsuda Orthopedic Memorial Hospital, Sapporo, Japan.
¹⁷ Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹⁸ Department of Orthopaedics, Saiseikai Shiga Hospital, Ritto, Japan.
¹⁹ Department of Orthopaedic Surgery, Gunma University, Graduate School of Medicine, Maebashi, Japan.
²⁰ Department of Orthopaedic Surgery, Nihon University Hospital, Tokyo, Japan.
²¹ Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan.
²² Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
²³ Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
²⁴ Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
²⁵ Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.
²⁶ Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan.
²⁷ Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
²⁸ Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
²⁹ Department of Orthopedics, Traumatology and Spine Surgery, Kawasaki Medical School, Kurashiki, Japan.
³⁰ Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
³¹ Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan.
³² Department of Orthopaedic Surgery, International University of Health and Welfare Narita Hospital, Narita, Japan.
³³ Department of Orthopaedic Surgery and Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
³⁴ Department of Orthopaedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
³⁵ Department of Orthopedics Surgery, Surgical Science, Tokai University School of Medicine, Isehara, Japan.
³⁶ Department of Orthopaedic Surgery, University of Yamanashi, Chuo, Japan.
³⁷ Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Yufu, Japan.
³⁸ Department of Orthopaedic Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.
³⁹ Department of Orthopaedic Surgery, Kitasato University School of Medicine, Sagamihara, Japan.

PMID: 39659382
PMCID: PMC11625708
DOI: 10.22603/ssrr.2024-0030

Abstract

Introduction: Elderly patients have a higher frequency of upper cervical fractures caused by minor trauma; nevertheless, the clinical differences between mid- and lower-cervical (C6-C7) injuries are unclear. The aim of this study was to compare the epidemiology of lower- and mid-cervical injuries in the elderly.

Methods: This multicenter, retrospective study included 451 patients aged 65 years or older who had mid- or lower-cervical fractures/dislocations. Patients' demographic and treatment data were examined and compared based on mid- and lower-cervical injuries.

Results: There were 139 patients (31%) with lower-cervical injuries and 312 (69%) with mid-cervical injuries. High-energy trauma (60% vs. 47%, p=0.025) and dislocation (55% vs. 45%, p=0.054) were significantly experienced more often by elderly patients with lower-cervical injuries than by patients with mid-cervical injuries. Although the incidence of key muscle weakness at the C5 to T1 levels were all significantly lower in patients with lower-cervical injuries than those with mid-cervical injuries, impairments at C5 occurred in 49% of them, and at C6, in 65%. No significant differences were found in the rates of death, pneumonia, or tracheostomy requirements, and no significant differences existed in ambulation or ASIA impairment scale grade for patients after 6 months of treatment.

Conclusions: Elderly patients with lower-cervical fractures/dislocations were injured by high-energy trauma significantly more often than patients with mid-cervical injuries. Furthermore, half of the patients with lower-cervical injuries had mid-cervical level neurological deficits with a relatively high rate of respiratory complications.

Keywords: cervical spinal cord injury; cervicothoracic injury; elderly; lower-cervical injury.

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Conflict of interest statement

Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.

Figures

**Figure 1.**
Patient selection flowchart. AO, AO (Arbeitsgemeinschaft für Osteosynthesefragen) Spine classification; AIS, ASIA (American Spinal Injury Association) impairment scale.

See this image and copyright information in PMC

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1. Asemota AO, Ahmed AK, Purvis TE, et al. Analysis of cervical spine injuries in elderly patients from 2001 to 2010 using a nationwide database: increasing incidence, overall mortality, and inpatient hospital charges. World Neurosurg. 2018;120:e114-30. - PubMed
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Comparative Analysis of Characteristics of Lower- and Mid-Cervical Spine Injuries in the Elderly

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Comparative Analysis of Characteristics of Lower- and Mid-Cervical Spine Injuries in the Elderly

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