Analysis of Cervical Spine Injuries in Elderly Patients from 2001 to 2010 Using a Nationwide Database: Increasing Incidence, Overall Mortality, and Inpatient Hospital Charges

Anthony O. Asemota, A. Karim Ahmed, Taylor E. Purvis, Peter G. Passias, C. Rory Goodwin, Daniel M. Sciubba

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Cervical spine (C-spine) injuries cause significant morbidity and mortality among elderly patients. Although the population of older-adults ≥65 years in the United States is expanding, estimates of the burden and outcome of C-spine injury are lacking. Methods: The Nationwide Inpatient Sample 2001–2010 was analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using U.S. Census data. Results: A total of 167,278 older adults were included. Median age was 81 years (interquartile range = 74–86). Most patients were female (54.9%), had Medicare coverage (77.6%), were treated in teaching hospitals (63.2%), and had falls as the leading injury mechanism (51.2%). ICF occurred in 91.3%, whereas CSCI occurred in 8.7% (P < 0.001). ICF was more common in ≥85-year-old patients and CSCI in 65- to 69-year-old patients (P < 0.001). The most common injured C-spine level in ICF was the C2 level (47.6%, P < 0.001) and in CSCI was C1–C4 level (4.5%, P < 0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, P < 0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, P < 0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (P < 0.001). Conclusions: In summary, C-spine fractures among U.S. older adults constitute a significant health care burden. ICFs occur commonly, C2-vertebra fractures are most frequent, whereas CSCIs are linked to increased hospital-resource use and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.

Original languageEnglish (US)
Pages (from-to)e114-e130
JournalWorld neurosurgery
Volume120
DOIs
StatePublished - Dec 2018

Keywords

  • Cervical spine fractures
  • Cervical spine surgery
  • Elderly
  • Isolated spinal cord injury
  • Mortality
  • Odontoid

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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