Mortality in Elderly Patients After Cervical Spine Fractures

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Mitchel B. Harris, MD1, William M. Reichmann, MA1, Christopher M. Bono, MD1, Kim Bouchard, BA1, Kelly L. Corbett, BA1, Natalie Warholic, MA1,Josef B. Simon, MD1, Andrew J. Schoenfeld, MD1, Lawrence Maciolek, MD1, Paul Corsello, BA1, Elena Losina, PhD1 and Jeffrey N. Katz, MD, MSc1

1 Department of Orthopedic Surgery (M.B.H., W.M.R., C.M.B., K.B., K.L.C., N.W., J.B.S., A.J.S., L.M., P.C., E.L., and J.N.K.), and the Division of Rheumatology, Immunology and Allergy (J.N.K.), Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115. E-mail address for M.B. Harris: mbharris@partners.org

Investigation performed at the Department of Orthopedic Surgery and the Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, Massachusetts

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from theProgram for Research Incubation and Development, Department of Orthopedic Surgery, Brigham and Women’s Hospital; the National Institutes of Health (P60 AR 47782 and K24 AR 02123); Synthes Spine; Stryker; DePuy; and Medtronic; and less than $10,000 from the Massachusetts Arthritis Foundation. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.


Background Despite an increased risk of cervical spine fractures in older patients, little is known about the mortality associated with these fractures and there is no consensus on the optimal treatment. The purposes of this study were to determine the three-month and one-year mortality associated with cervical spine fractures in patients sixty-five years of age or older and to evaluate potential factors that may influence mortality.

Methods We performed a retrospective review of all cervical spine fractures in patients sixty-five years of age or older from 1991 to 2006 at two institutions. Information regarding age, sex, race, treatment type, neurological involvement, injury mechanism, comorbidity, and mortality were collected. Overall risk of mortality and mortality stratified by the above factors were calculated at three months and one year. Cox proportional-hazard regression was performed to identify independent correlates of mortality.

Results Six hundred and forty patients were included in our analysis. The mean age was eighty years (range, sixty-five to 101 years). Two hundred and ninety-four patients (46%) were male, and 116 (18%) were nonwhite. The risk of mortality was 19% at three months and 28% at one year. The effect of treatment on mortality varied with age at three months (p for interaction = 0.03) but not at one year (p for interaction = 0.08), with operative treatment being associated with less mortality for those between the ages of sixty-five and seventy-four years. A higher Charlson comorbidity score, male sex, and neurological involvement were all associated with increased risk of mortality.

Conclusions Operative treatment of cervical spine fractures is associated with a lower mortality rate at three months but not at one year postoperatively for patients between sixty-five and seventy-four years old at the time of fracture.

Level of Evidence Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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