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More Study Needed for Cervical Spine Injury in Elderly

Posted on: 05/20/2010
Cervical spine injuries are injuries to the high upper back and neck, the cervical column. This part of the back consists of seven vertebrae, bones, that are connected with tough tissue called ligaments. Cervical spine injuries are usually the result of a trauma, such as a fall or a blow. Most often, they are found in young adults because of their activities, such as sports, or accidents, such as motor vehicle accidents. However, the elderly also may sustain this type of injury and, although they may not injure their upper spine as often as younger generations overall, they are at highest risk for doing so in a blunt trauma, such as a fall. And, when and if they have a cervical spine injury, the elderly are at a higher risk of death.

Researchers have been working on identifying this problem, particularly if the cause of death among the seniors are pre-existing health conditions (illnesses or disorder that exist before the injury), the injury itself, or the treatment used to manage the injury. The authors of this article reviewed the literature for studies on this topic, choosing to focus on the reporting of baseline characteristics (how the patients were when the injury occurred), follow-up, cause of death, and analysis of risk factors for mortality in studies that focused on specific treatments for cervical spinal injuries in the elderly.

Upon reviewing the literature, researchers found 26 studies that met their criteria. The combined number of elderly patients in the studies totaled 1550 subjects. Twenty-one studies (81 percent) were retrospective case series, looking back at files. Four (15 percent) were retrospective cohort studies, looking back at studies that compared the subjects, and one study (4 percent) was a prospective cohort study, a study that actively followed subjects through the study period.

The studies focused on the following injuries:

- Odontoid process fractures, a fracture of a piece of the second vertebrae in the back of the neck
- Upper cervical injuries
- Cervical spine injuries

Each study but one had patients who had other injuries along with the cervical spine injury. Of those 25 studies, 24 noted if there were spinal cord injuries and they were identified in one of several ways:

1 - complete versus incomplete injury
2 - Frankel classification, a scoring system related to how severe the neurological (nerve) loss is
3 - tetraplegia versus paraplegia, complete paralysis below the jaw versus versus paralysis below the waist
4 - ASIA International Standards for Neurologic Classification of Spinal Cord Injury classification
5 - neurologic level of injury
6 - noting presence or absence of injury in general

Only nine studies reported any comorbidities, pre-existing health problems.

Reports of causes of death found that 335 subjects died (22 percent), but four studies did not report if they were deaths soon after the injury or later on. In the other studies, 170 of the subjects, or 51 percent, died during admission or while the subjects were receiving treatments that did not involve surgery. Sixty-four subjects (19 percent) died during long-term follow-up. Unfortunately, for the group that died during admission or treatment, 15 studies do not report how long a time period this was.

In 155 of the cases (out of 335), no cause of death was reported. Among those that were reported, the cause of death couldn't be identified as it was listed as
unknown cause, unrelated cause, or medical conditions. For the subjects whose cause of death was recorded, most (116, or 34 percent) died of heart-related causes (cardiovascular), most often heart attacks.

The result of this review showed that there was no consistency in reporting on the issue of the elderly and the effects of cervical spine injury. This results in lack of information that could help health care providers identify the risks of this patient group when they present with a cervical spine injury. The authors recommend that further, consistent studies be undertaken to help this population as the baby boomer generation reaches older age.

Joost J. van Middendorp, MD, et al. Methodological Systematic Review: Mortality in Elderly Patients with Cervical Spine Injury. In Spine. May 1, 2010. Vol. 35. No. 10. Pp. 1079-1087.

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