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

References

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Miscellaneous