Fracture characteristics predict patient mortality after blunt force cervical trauma

Risk Factors and Outcomes of Surgical Site Infections of the Spine: A Retrospective Multi-Center Analysis

Background/Objectives: Surgical site infections (SSIs) in spine surgery pose significant risks, including neurological deficits, prolonged hospital stays, and increased healthcare costs. SSIs are classified by their location and include superficial, deep, and organ/space (OS) infections. In spine surgery, OS SSIs include osteomyelitis, discitis, and spinal epidural abscess. These infections are difficult to treat with conservative measures, impart significant morbidity, and incur increasing hospital costs. Despite advancements in surgical technique and infection control, the literature is conflicting on which factors are associated with a significant increase in risk of SSIs after spinal surgery. There is also a significant gap in the literature in defining the risk factors specific to OS SSIs. This study aims to identify risk factors associated with SSI after spine surgery at a single institution, as well as provide descriptive characteristics of patients with OS SSIs. Methods: This retrospective study analyzed spinal surgeries performed at a multi-center, single-institution between 1 January 2019 and 9 February 2025. Neurosurgical patients who underwent spine surgery were identified by ICD-10 procedure and diagnosis codes. Surgical infections were classified based on the National Healthcare Safety Network (NHSN) criteria. Univariate and multivariate analyses were performed to assess associations between patient demographics, comorbidities, and infection risk. Results: Of the 2363 unique spinal surgery patients, 39 developed infections, with 14 meeting the NHSN criteria for OS SSI. The overall rate of SSIs at this institution was 1.65%. Significant risk factors for developing an SSI included cardiovascular disease (p = 0.017) and COPD (p = 0.012). Multivariate analysis confirmed both risk factors identified in the univariate analysis as independent risk factors, with adjusted odds ratios of 1.97 (p = 0.033) and 2.072 (p = 0.041), respectively. The commonly cultured pathogens included Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant Staphylococcus aureus. Conclusions: Male sex, diabetes mellitus, gastroesophageal reflux disease, hyperlipidemia, hypertension, hardware placement, and a history of smoking were more common in patients with SSI. In the OS SSI subgroup, cardiovascular disease and COPD were associated with an increased risk of developing an OS SSI. Future research is needed to investigate more detailed risk factors and include mitigating factors of OS infection into the analysis.

Postmortem kinetic CT of the cervical spine and an objective index for diagnosing anterior disc space widening: A retrospective utility analysis

Postmortem CT has limitations in identifying cervical spine injuries. Injuries at the level of the intervertebral disc (anterior disc space widening), such as rupture of the anterior longitudinal ligament or intervertebral disc, may be difficult to distinguish from normal images depending on the imaging position. We performed postmortem kinetic CT of the cervical spine in the extended position in addition to CT in the neutral position. The difference in intervertebral angles between the neutral and extended positions was defined as the intervertebral range of motion (ROM), and the utility of postmortem kinetic CT of the cervical spine for the diagnosis of anterior disc space widening and its objective index were examined based on the intervertebral ROM. Of 120 cases, 14 had anterior disc space widening: 11 had one lesion and 3 had two lesions. The intervertebral ROM for the 17 lesions was 11.85° ± 5.25° and that for the normal vertebrae was 3.78° ± 2.81°, with a significant difference between the two. ROC analysis of the intervertebral ROM between vertebrae with anterior disc space widening and the normal vertebral spaces showed an AUC of 0.903 (95 % confidence interval 0.803-1) and a cutoff value of 8.61° (sensitivity 0.96, specificity 0.82). Postmortem kinetic CT of the cervical spine revealed that the intervertebral ROM of the anterior disc space widening was increased, which facilitated identification of the injury. An intervertebral ROM that exceeds 8.61° facilitates a diagnosis of anterior disc space widening.

Predicting survival in older patients treated for cervical spine fractures: development of a clinical survival score

BACKGROUND CONTEXT

Emerging literature has identified the importance of pretreatment health and functional status as influential in the prognostication of survival. A comprehensive, accessible, predictive model for survival following cervical spine fracture has yet to be developed.

PURPOSE

To develop an accessible and intuitive predictive model for survival in individuals aged 50 and older treated for cervical spine fractures.

STUDY DESIGN

Retrospective review of records from two tertiary care centers (2009-2016).

PATIENT SAMPLE

Patients age 50 and older who received operative or nonoperative management for cervical fractures.

OUTCOME MEASURES

One-year mortality was the primary outcome with 3-month and 2-year mortality considered secondarily.

METHODS

Multivariable logistic regression was used to identify factors independently associated with mortality. The magnitude and precision of the relationship with 1-year mortality for statistically significant variables determined weighting in the scoring system subsequently developed. Score performance was tested through multivariable regression and bootstrap simulation. In a sensitivity test, the performance of the score developed for 1-year mortality was assessed using figures for the 3-month and 2-year time-points.

RESULTS

We included 1,758 patients. Mortality rates were 12% at 3 months, 17% at 1 year, and 21% at 2 years. Following multivariable testing age, injury severity score and Glasgow coma scale demonstrated the strongest predictive values for a base score, followed by serum albumin and ambulatory status. The resultant composite score ranged from 0 (base score≤4, albumin≤3.5 g/dL, and dependent/nonambulator at presentation) to a maximum of 4 (base score≥5, albumin>3.5 g/dL, and independent ambulator at presentation). Following multivariable analysis, when compared to patients with a score of 4, significantly increased odds of 1-year mortality were appreciated for those with scores of 3 (odds ratio [OR] 7.35; 95% confidence interval [CI] 3.77, 14.32), 2 (OR 8.43; 95% CI 4.66, 15.25), 1 (OR 17.47; 95% CI 9.81, 31.11), and 0 (OR 26.58; 95% CI 13.87, 50.92). Score performance was unchanged in bootstrap testing and sensitivity analyses.

CONCLUSIONS

We have developed a useful prognostic utility capable of informing survival in individuals age 50 and older, following cervical spine fractures. The score can be applied to adjust patient expectations, anticipate outcomes, and as an adjunct to decision-making in the postinjury period.

Predictors for mortality in elderly patients with cervical spine injury: a systematic methodological review

STUDY DESIGN

Systematic methodological review.

OBJECTIVE

Identify predictors for cervical spine injury (CSI) mortality in elderly patients by reviewing the available literature.

SUMMARY OF BACKGROUND DATA

The proportion of active elderly individuals in society is increasing. This population is at high risk for CSI mortality. The results of studies identifying predictors for CSI mortality in the elderly population are often inconclusive or even conflicting. Currently, there is no set of predictors that can adequately identify and describe CSI mortality risk for the elderly. Thus, we performed a systematic review to identify the predictors for mortality in elderly patients with CSI.

METHODS

We performed searches in the MEDLINE, EMBASE, ScienceDirect, and OVID databases (articles published prior to May 2012) for noninterventional studies that evaluated predictors for CSI mortality in the elderly. Only those observational studies with eligible data were included. Study quality was assessed using a modified quality assessment tool that was designed previously for an observational study. Study outcomes were combined with study quality scores using a best-evidence synthesis model.

RESULTS

Twenty-three observational studies involving 2325 patients were included. These studies were published between 1993 and 2011. According to the quality assessment criteria, 8 studies were of high quality, 11 studies were of moderate quality, and 4 studies were of low quality. We identified 3 strong evidence predictors for CSI mortality, including pre-existing comorbidities, spinal cord injury, and age. We also identified 3 moderate evidence predictors, 7 limited evidence predictors and 1 conflicting evidence predictor.

CONCLUSION

Although there is no conclusive evidence regarding the mortality of elderly patients with CSI, these data provide information that can help us to make recommendations and to counsel patients and their families. Special attention should be paid to the 3 strong predictors. Further studies will be required to validate these predictors.