Cervical spine injuries in the elderly: Acute postoperative mortality

Study Design. This study retrospectively reviewed 12 years of consecutive patients with cervical spine injuries. Objective. To establish reasonable expectations for short-term postoperative survival of the elderly patient with a cervical spine injury. Summary of Background Data. Previous studies have outlined dismal expectations for patients older than 65 years, with cervical spine injuries. This result has led many surgeons to consider more conservative treatment when compared to younger patients with similar injuries. Methods. A total of 458 patients treated surgically over a 12-year period at a single tertiary spine care center were reviewed. The patients were divided into 2 groups by age, older and younger than 65 years. Prospective data were collected from the time of admission to discharge from the acute care facility, and included age, injury etiology, anatomic and neurologic injury patterns, and morbidity and mortality Results. There were 74 patients older than 65 years and 384 younger than 65 years who underwent surgical stabilization of their injury. The overall mortality rate during the initial hospitalization was 3.9%. The mortality rate of the elderly group was 12.2%, while 2.3% for the younger patients. Common postoperative morbidities in the older group included myocardial infarction, deep vein thrombosis, pulmonary emboli, and gastrointestinal bleeds. In the younger group, pneumonia, respiratory failure, and urinary tract infections were more frequent. Conclusions. The realistic expectation for short-term postoperative survival in the elderly patient with a cervical spine injury is 87.8%. With a complete neurologic injury, 80.0% short-term survival was observed. Incomplete neurologic injury yielded 83.3% short-term survival. Close to 100.0% survival can be expected with no neurologic injury.