Cervical spine injuries in patients 65 and older

Abstract

Study design: This study was a retrospective data-base review of patients with cervical injuries admitted to a regional spinal cord injury center over a 9-year period.

Objectives: Patients < 40 and > or = 65 were analyzed separately to determine differences in etiology, neurologic findings, mortality, and neurologic recovery.

Summary of background data: Previous studies of cervical injuries in older patients have found a high percentage of falling as an etiology, a high incidence of injuries to C2, and a high mortality rate with spinal cord injury (SCI).

Methods: Three databases containing information on all SCI patients, SCI patients with 1-2 year follow-up, and neurogically intact spinal injury patients were reviewed retrospectively.

Results: A higher percentage of older patients had cervical injuries, and this group did not show the typical male predominance seen in young patients (4:1 vs. 1:1). Neurologic deficits were more common in the younger age group. In the older patients, falls were a much more common etiology, and upper cervical injuries, especially odontoid fractures, predominated. Cervical spondylosis and stenosis were more common in the older patients, and the mortality with associated SCI was 60 times higher than in younger patients. Younger patients more commonly had complete neurologic injuries, but had more early functional motor return in incomplete lesions. The older patients did show late functional return in incomplete deficits.

Conclusions: Cervical spine injury commonly occurs with relatively minor trauma in patients > or = 65, with a mortality rate of approximately 26% with associated SCI. Return of functional motor recovery is delayed in older patients with incomplete deficits, but can be expected. C2 injuries, especially odontoid fractures, must be ruled out in older patients with neck pain after even a minor injury.