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Lee S, Hur JW, Oh Y, An S, Yun GY, Ahn JM. Current Concepts in the Treatment of Traumatic C2 Vertebral Fracture : A Literature Review. J Korean Neurosurg Soc 2024; 67:6-13. [PMID: 37461838 PMCID: PMC10788552 DOI: 10.3340/jkns.2023.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 01/17/2024] Open
Abstract
The integrity of the high cervical spine, the transition zone from the brainstem to the spinal cord, is crucial for survival and daily life. The region protects the enclosed neurovascular structure and allows a substantial portion of the head motion. Injuries of the high cervical spine are frequent, and the fractures of the C2 vertebra account for approximately 17-25% of acute cervical fractures. We review the two major types of C2 vertebral fractures, odontoid fracture and Hangman's fracture. For both types of fractures, favorable outcomes could be obtained if the delicately selected conservative treatment is performed. In odontoid fractures, as the most common fracture on the C2 vertebrae, anterior screw fixation is considered first for type II fractures, and C1-2 fusion is suggested when nonunion is a concern or occurs. Hangman's fractures are the second most common fracture. Many stable extension type I and II fractures can be treated with external immobilization, whereas the predominant flexion type IIA and III fractures require surgical stabilization. No result proves that either anterior or posterior surgery is superior, and the surgeon should decide on the surgical method after careful consideration according to each clinical situation. This review will briefly describe the basic principles and current treatment concepts of C2 fractures.
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Affiliation(s)
- Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Junseok W Hur
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Younggyu Oh
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Sungjae An
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gi-Yong Yun
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jae-Min Ahn
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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ElNemer W, Solomon E, Raad M, Jain A, Lee SH. Predicting Mortality Following Odontoid Fracture Fixation in Elderly Patients: CAADS-16 Score. Global Spine J 2023:21925682231220019. [PMID: 38037824 DOI: 10.1177/21925682231220019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
STUDY DESIGN Retrospective Review of a National Database. INTRODUCTION By utilizing a national database, this study aims to quantify the predictors of 30-day mortality after odontoid fixation and guide appropriate management for patients in whom the choice between operative and non-operative management is unclear. METHODS The American College of Surgeons National Surgical Quality Improvement Database was queried using Current Procedural Terminology (CPT) codes and International Classification of Disease (ICD) codes to identify patients 60 or older who underwent surgical fixation of an odontoid fracture from 2005 to 2020. Risk factors for mortality significant in univariate and subsequent multivariate analysis were used to develop a scoring system to predict post-operative mortality. RESULTS 608 patients were identified. Patients were split into a non-mortality 30 days post-op group, and into a mortality 30 days post-op group. The following risk factors were included in the scoring system: functional dependency, disseminated cancer, albumin less than 3.5, WBC count greater than 16 k, anterior surgical approach, and pre-op SIRS. Using a cutoff value of 2, the CAAD-16 score had a sensitivity and specificity of 82% and 81%, respectively. The ASA score, cutoff at 4, showed a sensitivity and specificity of 64% and 75% respectively. CONCLUSIONS This sample of 294 patients represents one of the largest samples of odontoid fracture fixation patients available in the literature and comes from a nationally representative database. We structure relevant risk factors into the CAADS-16 score, which has the potential to be a clinically relevant tool to prevent short-term postoperative mortality.
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Affiliation(s)
- William ElNemer
- School of Medicine, The Johns Hopkins University, Baltimore, MD, USA
| | - Eric Solomon
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Micheal Raad
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Amit Jain
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sang Hun Lee
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
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Operative Versus Nonoperative Management of Unstable Spine Fractures in the Elderly: Outcomes and Mortality. Spine (Phila Pa 1976) 2023; 48:39-48. [PMID: 36083602 DOI: 10.1097/brs.0000000000004466] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/21/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess outcomes and mortality in elderly patients following unstable spine fractures depending on treatment modality. SUMMARY OF BACKGROUND DATA Operative management of unstable spine fractures in the elderly remains controversial due to increased risk of perioperative complications. Mortality rates after operative versus nonoperative treatment of these injuries have not been well-characterized. MATERIALS AND METHODS Patients aged above 65 with unstable spine fractures without neurologic injury from 2015 to 2021 were identified from the Clinformatics ® Data Mart (CDM) Database. Demographics, complications, and mortality were collected. Multivariable logistic regression was used to adjust for the effect of baseline characteristics on mortality following unstable fracture diagnosis. RESULTS Of the 3688 patients included, 1330 (36.1%) underwent operative management and 2358 (63.9%) nonoperative. At baseline, nonoperative patients were older, female, had higher Elixhauser comorbidity scores, and were more likely to have a cervical fracture. Operative patients had a longer length of stay in the hospital compared with nonoperative patients (9.7 vs. 7.7 days; P <0.001). Although patients in the operative group had higher rates of readmission at 30, 60, 90, and 120 days after diagnosis ( P <0.01), they had lower mortality rates up to five years after injury. After adjusting for covariates, nonoperative patients had a 60% greater risk of mortality compared with operative patients (hazard ratio: 1.60, 95% confidence interval: 1.40-1.78, P <0.001). After propensity score matching, operative patients age 65 to 85 had greater survivorship compared with their nonoperative counterparts. CONCLUSIONS Elderly patients with an unstable spine fracture who undergo surgery experience lower mortality rates up to five years postdiagnosis compared with patients who received nonoperative management, despite higher hospital readmission rates and an overall perioperative complication rate of 37.3%. Operating on elderly patients with unstable spine fractures may outweigh the risks and should be considered as a viable treatment option in appropriately selected patients.
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Differences in clinical characteristics of cervical spine injuries in older adults by external causes: a multicenter study of 1512 cases. Sci Rep 2022; 12:15867. [PMID: 36151125 PMCID: PMC9508126 DOI: 10.1038/s41598-022-19789-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022] Open
Abstract
Although traumatic cervical spine injuries in older adults are commonly caused by minor traumas, such as ground-level falls, their prognosis is often unfavorable. Studies examining the clinical characteristics of cervical spine injuries in older adults according to the external cause of injury are lacking. This study included 1512 patients of ≥ 65 years of age with traumatic cervical spine injuries registered in a Japanese nationwide multicenter database. The relationship between the external causes and clinical characteristics, as well as factors causing unfavorable outcomes at the ground-level falls, were retrospectively reviewed and examined. When fall-induced cervical spine injuries were categorized and compared based on fall height, the patients’ backgrounds and injury statuses differed significantly. Of note, patients injured from ground-level falls tended to have poorer pre-injury health conditions, such as medical comorbidities and frailty, compared with those who fell from higher heights. For ground-level falls, the mortality, walking independence, and home-discharge rates at 6 months post-injury were 9%, 67%, and 80%, respectively, with preexisting medical comorbidities and frailty associated with unfavorable outcomes, independent of age or severity of neurological impairment at the time of injury.
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5
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Garay RS, Solitro GF, Lam KC, Morris RP, Albarghouthi A, Lindsey RW, Latta LL, Travascio F. Characterization of regional variation of bone mineral density in the geriatric human cervical spine by quantitative computed tomography. PLoS One 2022; 17:e0271187. [PMID: 35802639 PMCID: PMC9269429 DOI: 10.1371/journal.pone.0271187] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Odontoid process fractures are among the most common in elderly cervical spines. Their treatment often requires fixation, which may include use of implants anteriorly or posteriorly. Bone density can significantly affect the outcomes of these procedures. Currently, little is known about bone mineral density (BMD) distributions within cervical spine in elderly. This study documented BMD distribution across various anatomical regions of elderly cervical vertebrae. Methods and findings Twenty-three human cadaveric C1-C5 spine segments (14 males and 9 female, 74±9.3 y.o.) were imaged via quantitative CT-scan. Using an established experimental protocol, the three-dimensional shapes of the vertebrae were reconstructed from CT images and partitioned in bone regions (4 regions for C1, 14 regions for C2 and 12 regions for C3-5). The BMD was calculated from the Hounsfield units via calibration phantom. For each vertebral level, effects of gender and anatomical bone region on BMD distribution were investigated via pertinent statistical tools. Data trends suggested that BMD was higher in female vertebrae when compared to male ones. In C1, the highest BMD was found in the posterior portion of the bone. In C2, BMD at the dens was the highest, followed by lamina and spinous process, and the posterior aspect of the vertebral body. In C3-5, lateral masses, lamina, and spinous processes were characterized by the largest values of BMD, followed by the posterior vertebral body. Conclusions The higher BMD values characterizing the posterior aspects of vertebrae suggest that, in the elderly, posterior surgical approaches may offer a better fixation quality.
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Affiliation(s)
- Ryan S. Garay
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, Florida, United States of America
| | - Giovanni F. Solitro
- Louisiana State University Health-Shreveport, Shreveport, Louisiana, United States of America
| | - Kenrick C. Lam
- University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Randal P. Morris
- University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Abeer Albarghouthi
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, Florida, United States of America
| | - Ronald W. Lindsey
- University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Loren L. Latta
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, Florida, United States of America
- Department of Orthopaedic Surgery, University of Miami, Miami, Florida, United States of America
| | - Francesco Travascio
- Department of Mechanical and Aerospace Engineering, University of Miami, Coral Gables, Florida, United States of America
- Max Biedermann Institute for Biomechanics, Mount Sinai Medical Center, Miami Beach, Florida, United States of America
- Department of Orthopaedic Surgery, University of Miami, Miami, Florida, United States of America
- Department of Industrial Engineering, University of Miami, Coral Gables, Florida, United States of America
- * E-mail:
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Wang B, Jin J, Shao ZX, Yang GY, Lin Y, Xu HZ, Xie CL, Chen JX, Zhang XL, Hong ZH, Wang XY. Wright's Technique with the Addition of Visualized Axial Cortical Windows in Odontoid Fractures. Orthop Surg 2021; 14:443-450. [PMID: 34914198 PMCID: PMC8867410 DOI: 10.1111/os.13012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 11/30/2022] Open
Abstract
This study sought to investigate and evaluate a modified axial translaminar screw fixation for treating odontoid fractures. We performed a retrospective study at Wenzhou Medical University Affiliated Second Hospital between March 2016 and June 2018. We retrospectively collected and analyzed the medical records of 23 cases with odontoid fractures. All patients were identified as type II odontoid fractures without neurological deficiency and serious diseases following the classification of Anderson. The average age, gender ratio, and body mass index (BMI) were 54.3 ± 11.1 years, 12 men to 11 women, and 22.6 ± 2.4 kg/m2 , respectively. Patients in this study accepted screw fixation using our modified axial translaminar screw fixation combined with atlas pedicle or lateral mass screw fixation. Within the technique, a small cortical "window" was dug in the middle of the axial contralateral lamina, such that the screws in the lamina were visualized to prevent incorrectly implanting the posterior spinal canal through the visualized "window." A total of 46 bone screws were accurately inserted into the axial lamina without using fluoroscopy. The length of all translaminar screws ranged between 26 and 30 mm, while the diameter was 3.5 mm. During the follow-up survey, the visual analog scale (VAS) and neck disability index (NDI) were measured. We provide a simple modification of Wright's elegant technique with the addition of "visualized windows" at the middle of the axial lamina. In all patients, screws were inserted accurately without bony breach and the screw angle was 56.1 ± 3.0°. Mean operative time was 102 ± 28 min with an average blood loss of 50 ± 25 mL. Postoperative hemoglobin and mean length of hospital stay were 12.0 ± 1.4 g/dL and 10.4 ± 3.4 days, respectively. The average follow-up time of all cases was 14.7 months and no internal fixation displacement, loosening, or breakage was found. All patients with odontoid fractures reported being satisfied with the treatment during the recheck period and good clinical outcomes were observed. At 1, 6, and 12 months, NDI and VAS showed that the symptoms of neck pain and limitations of functional disability improved significantly during follow-up. Our results suggest that the modified translaminar screw fixation technique can efficiently treat Anderson type II odontoid fracture, followed by the benefits of less soft tissue dissection, simple operation, no fluoroscopy, and accurate placement of screws.
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Affiliation(s)
- Ben Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China.,Orthopaedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Zhen-Xuan Shao
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Guang-Yong Yang
- Orthopaedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Yan Lin
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Hua-Zi Xu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Cheng-Long Xie
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Jiao-Xiang Chen
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Xiao-Lei Zhang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
| | - Zheng-Hua Hong
- Orthopaedic Department, Taizhou Hospital Affiliated to Wenzhou Medical University, Linhai, China
| | - Xiang-Yang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.,The Second School of Medicine, Wenzhou Medical University, Wenzhou, China.,Laboratory of Orthopaedics of Zhejiang Province, Wenzhou, China
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Bilateral medial medullary syndrome following anterior screw fixation of type 2 odontoid fracture, a case report of two patients. Spinal Cord Ser Cases 2021; 7:101. [PMID: 34799551 DOI: 10.1038/s41394-021-00462-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 10/26/2021] [Accepted: 11/02/2021] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Medial medullary syndrome (MMS) has not been reported after anterior screw fixation of an odontoid type 2 fracture. CASE PRESENTATION We report on two cases who suffered from an unstable type 2 odontoid fracture following a skiing and a domestic fall accident. Prior to anterior screw fixation surgery both patients presented without neurologic deficits but postoperatively developed a bilateral MMS, including an incomplete tetraparesis, impaired sensation of position and movement as well as tactile discrimination and paralysis of the tongue muscle with deviation to the paralyzed side. MRI showed a typical heart-shaped ischaemic lesion in the medial medulla bilaterally. The search for aetiologic factors was uneventful in both patients except for severe atherosclerosis. DISCUSSION Due to the close proximity of the ischaemic area to the surgical site, we here propose the perioperative mechanical manipulation of the upper cervical spine during surgery of patients with atherosclerosis as a new aetiology for MMS.
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9
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Tarawneh A, Taqvi S, Salem K, Sahota O. Cervical spine fragility fractures in older people: 5-year experience at a regional spine centre. Age Ageing 2020; 49:1102-1104. [PMID: 32520992 DOI: 10.1093/ageing/afaa088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less. Atlanto-axial complex (AAC) and, particularly, odontoid process (OP) fractures are the most prevalent injuries. OBJECTIVE to investigate the incidence and characteristics of cervical spine fractures in older patients presenting to a regional spine centre. METHODS a retrospective review of the clinical records and imaging of all patients aged 70 years and over presenting to a regional spinal unit with a cervical injury over a 5-year period was performed. Patient demographics, mechanism of injury, level of fracture, stability of the fracture, treatment modality, imaging modality and mortality rates were collected and analysed. RESULTS during the period between 2015 and 2019, a total of 209 patients aged 70 years and over were presented to the regional spine unit. The mean age at presentation was 82.4 (±7.5) years. Low-energy trauma was the commonest mechanism of injury (n = 169; 80.9%). MRI was undertaken in a quarter of the patients. One-hundred and fifty-one patients (72.2%) suffered an AAC Injury with OP fractures forming the majority of this group (n = 119; 78.8%). One-hundred and ninety-nine patients were treated conservatively, and the overall 30-day mortality rate was 8.1%. CONCLUSION cervical spine fractures are not uncommon amongst older people and are mostly the result of low-energy trauma and predominantly affect the axial cervical spine. The majority of these injuries are managed conservatively with an orthosis. The fractures nevertheless are a serious injury, with a high mortality rate at 30 days.
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Affiliation(s)
- Ahmad Tarawneh
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Syed Taqvi
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Khalid Salem
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Opinder Sahota
- Department of Healthcare of Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
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10
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Kannus P, Niemi S, Parkkari J, Mattila VM. Sharp Rise in Fall-Induced Cervical Spine Injuries Among Older Adults Between 1970 and 2017. J Gerontol A Biol Sci Med Sci 2020; 75:2015-2019. [PMID: 31811293 DOI: 10.1093/gerona/glz283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Fall-induced injuries in older adults are a major public health challenge. METHODS We determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2017. Similar patients aged 20-49 years served as a reference group. RESULTS The annual number of fall-induced severe cervical spine injuries among older Finnish adults rose steeply during the follow-up, from 59 in 1970 to 502 in 2017. The age-adjusted incidence of injury (per 100,000 persons) was higher in men than women throughout this period and showed a clear increase from 1970 to 2017: from 8.4 to 25.0 in men, and from 2.8 to 13.9 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 80 years or older. In the reference group, the injury incidence declined by time. CONCLUSIONS The number and incidence of fall-induced severe cervical spine injuries among older Finns showed a sharp rise between 1970 and 2017. An increase in the average risk of serious falls may partly explain the phenomenon. Effective fall and injury prevention measures are urgently needed since further aging of the population is likely to aggravate the problem in the near future.
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Affiliation(s)
- Pekka Kannus
- Department of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere.,Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Seppo Niemi
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Ville M Mattila
- Department of Orthopedics and Traumatology, Tampere University Hospital, and Faculty of Medicine and Health Technology, University of Tampere, Tampere
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Gorman E, DiMaggio C, Frangos S, Klein M, Berry C, Bukur M. Elderly Patients With Cervical Spine Fractures After Ground Level Falls Are at Risk for Blunt Cerebrovascular Injury. J Surg Res 2020; 253:100-104. [DOI: 10.1016/j.jss.2020.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/14/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
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12
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Barbat A, Partiali B, Oska S, Folbe A. Head, Face, and Neck Fractures Secondary to Ladder-Related Injuries Treated in United States Emergency Departments in 2009-2018. J Emerg Med 2020; 59:186-192. [PMID: 32561108 DOI: 10.1016/j.jemermed.2020.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/01/2020] [Accepted: 04/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ladders are a commonly used piece of equipment; however, their use is accompanied by a significant potential for injury. Fractures of the head, face, and neck are potential consequences of ladder use and can be devastating due to potential for severe sequalae. OBJECTIVES To describe the frequency and pattern of ladder-related head, face, and neck fractures from 2009-2018. METHODS The National Electronic Injury Surveillance System (NEISS) was searched for ladder-related head, face, and neck fractures treated in U.S. emergency departments. Demographics, mechanism of injury, fracture type, setting in which fracture occurred, and patient disposition were analyzed. RESULTS There were 601 total cases (weighted national estimate of 20,450 total cases) of ladder-related head, face, and neck fractures obtained from the NEISS from 2009 to 2018. The mean age of injury was 53 years, and the majority of cases occurred in home settings. Approximately 25% of the cases were patients aged older than 65 years. The majority of fractures in individuals younger than 18 years and older than 46 years of age resulted in admission. The most commonly fractured locations included the face (51.0%), followed by cervical spine (28.3%) and cranial (20.7%) fractures. CONCLUSIONS Admission rates for ladder-related head, face, and neck fractures are substantially higher than those previously reported for all types of ladder-related injuries. Injury and admission patterns vary by age. Rigorous safety precautions may be indicated for the high-risk groups identified by this study, especially the elderly.
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Affiliation(s)
- Antonio Barbat
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Benjamin Partiali
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Sandra Oska
- Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Adam Folbe
- Division of Otolaryngology Head and Neck Surgery, Rhinology and Endoscopic Skull Base Surgery, William Beaumont Hospital, Royal Oak, Michigan
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13
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Wenning KE, Hoffmann MF. Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? J Orthop Surg Res 2020; 15:8. [PMID: 31918713 PMCID: PMC6953136 DOI: 10.1186/s13018-019-1525-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/18/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. METHODS Over a 5-year period (2010-2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. RESULTS Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). CONCLUSION Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.
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Affiliation(s)
- Katharina E Wenning
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789, Bochum, Germany.
| | - Martin F Hoffmann
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789, Bochum, Germany
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Khanpara S, Ruiz-Pardo D, Spence SC, West OC, Riascos R. Incidence of cervical spine fractures on CT: a study in a large level I trauma center. Emerg Radiol 2019; 27:1-8. [PMID: 31463806 DOI: 10.1007/s10140-019-01717-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION/PURPOSE Though spinal fractures constitute a minority of all traumas, the financial burden imposed is immense especially following cervical spine trauma. There have been several papers in the past describing the incidence of cervical spine fractures. In this paper, we report the incidence of cervical spine fractures and correlate with demographic information and cause of injury and review the mechanism of fractures. MATERIALS AND METHODS We performed retrospective analysis of 934 patients who had undergone CT scan for cervical spine trauma at our institute which includes 16 hospitals and one level I trauma center over a period of 2 years. This list was created from a wider database of 13,512 patients imaged for suspected cervical spine injury. All patients who had at least one positive finding on CT were included in this study irrespective of any demographic difference. Each patient was analyzed by reviewing the medical records, and correlation was sought between demographics and cause of injury. RESULTS In our study, the peak incidence of cervical spine trauma was in the age group of 21-30 years followed by 31-40 years with a male:female ratio of 2.1. The major cause of injury in the study population was motor vehicle accidents (66.1%), followed by fall from height of less than 8 ft (12.2%). With regard to the ethnic distribution, Caucasians (46.9%) constituted the major population followed by Hispanic population (23.3%). C1 and C2 were observed to be more frequently fractured as compared with the subaxial spine. Incidence of C2 fractures (188 levels) was higher as compared with C1 (102 levels). Incidence of body and lateral mass fractures was marginally higher as compared with odontoid fractures. C7 (50 levels) was the most fractured vertebral body in the subaxial spine followed by C6 (35 levels) and C5. CONCLUSION Spinal trauma is on the rise and it helps to know the factors which can guide us for better management of these patients. We can utilize these results to prognosticate and streamline clinical management of these patients.
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Affiliation(s)
- Shekhar Khanpara
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States.
| | | | - Susanna C Spence
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States
| | - O Clark West
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States
| | - Roy Riascos
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 2-130B, Houston, TX 77030, United States
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15
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Galganski LA, Cox JA, Greenhalgh DG, Sen S, Romanowski KS, Palmieri TL. Cervical Spine Injury in Burned Trauma Patients: Incidence, Predictors, and Outcomes. J Burn Care Res 2019; 40:263-268. [PMID: 30801641 DOI: 10.1093/jbcr/irz022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cervical spine injuries (CIs) carry significant morbidity and mortality; hence, cervical spine immobilization is used liberally in trauma patients, including burns. The incidence, predictors, and outcomes of CI in burn patients are unknown. A retrospective cohort from the National Trauma Data Bank between 2007 and 2012 included all burned patients with and without CI. Predictors of CI were identified by logistic regression. Outcomes with and without CI were compared with Wilcoxon rank sum test. A total of 94,964 patients were identified with burn injuries. The incidence of CI was 0.79% (n = 745). Mechanism of injury, age, and injury severity score (ISS) were significant predictors of CI. Odds of CI were 109.4 (95% CI: 61.2-195.3, P < .0001) for motor vehicle injury, 87.8 (95% CI: 47.0-164.0, P < .0001) for falls, 1.2 (95% CI: 0.6-2.3, P = .66) for fire/flame, and 2.4 (95% CI: 1.0-5.5, P < .0001) for explosion compared with reference of hot object/substance. For every year increase in age, there were 1.02 higher odds of CI (95% CI: 1.01-1.02, P < .0001). For each point increase in ISS, there were 1.05 higher odds of CI (95% CI: 1.04-1.05, P < .0001). Patients with CI had higher mortality (10.3% vs 2.9%, P < .0001), longer total length of stay (12.0 vs 2.0 days, P < .0001), intensive care unit length of stay (4.0 vs 0.0 days, P < .001), and ventilator days (1.0 vs 0.0 days, P < .0001). The incidence of CI in burn patients is low, especially when due to fire, flame, or scalds; however, CI is associated with higher mortality and worse outcomes.
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Affiliation(s)
- Laura A Galganski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Jessica A Cox
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - David G Greenhalgh
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Soman Sen
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Kathleen S Romanowski
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
| | - Tina L Palmieri
- Department of Surgery, Division of Burn Surgery, University of California, Davis, California.,Shriners Hospital for Children - Northern California, Sacramento, California
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Yokota K, Maeda T, Kawano O, Mori E, Takao T, Sakai H, Masuda M, Morishita Y, Hayashi T, Kubota K, Nakashima Y. Progression of local kyphosis after conservative treatment for compressive cervical spine fracture with spinal cord injury. J Orthop Surg Res 2019; 14:98. [PMID: 30971275 PMCID: PMC6458645 DOI: 10.1186/s13018-019-1115-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 03/06/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Compressive-flexion type cervical spine fracture is typically accompanied by apparent dislocation of the facet joints, undesirable cervical alignment, and devastating neurological dysfunction, which provides strong rationale for rendering prompt operative treatment. However, the validity of conservative treatment for compressive-flexion cervical spine injury in cases with preserved congruity of the facet joints has yet to be elucidated. The purpose of this study is to evaluate the long-term outcome of cervical alignment following conservative treatment for compressive-flexion cervical spine injury with preserved congruity of the facet joints. Methods A total of 662 patients who experienced spinal cord injury from 2007 to 2017 were included and underwent retrospective review in a single institute. Thirteen patients were identified as receiving conservative therapy following compressive-flexion cervical spine fractures with spinal cord injury. Clinical and radiological results were collected, including vertical fractures of the vertebral column, laminar fractures, progression of local kyphosis, and neurological status. The degree of the local cervical kyphosis was evaluated with two methods: the posterior tangent method and the endplate method. Results All 13 patients were male, and the mean age at the time of injury was 28.4 years. The mean follow-up period was 3 years. Although none of the patients presented neurological deterioration after the injury, the degree of local kyphosis was increased at the time of final follow-up compared to what was observed at the time of injury. Patient age at the time of injury and concurrent vertical fracture of vertebral body could have been influencing factors for the progression of the kyphosis. While laminar fracture affected the kyphosis at the time of injury, it was not a strong influencing factor of the overall progression of local kyphosis. Conclusions The conservative option for the compressive-flexion cervical injury allowed us to treat without exacerbating neurological symptoms as long as the facet joints are preserved. However, in terms of cervical alignment, surgical stabilization may have been desirable for these patients. Notably, the younger patients and the patients with vertical fracture of the cervical vertebral column in this type of injury required closer observation to help prevent the progression of local kyphosis.
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Affiliation(s)
- Kazuya Yokota
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan. .,Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan. .,Division of Genetics and Development, Krembil Research Institute, University Health Network, 60 Leonard Avenue, Toronto, ON, M5T2S8, Canada.
| | - Takeshi Maeda
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Osamu Kawano
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Eiji Mori
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Tsuneaki Takao
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Hiroaki Sakai
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Muneaki Masuda
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Yuichiro Morishita
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Tetsuo Hayashi
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Kensuke Kubota
- Department of Orthopaedic Surgery, Japan Labor Health and Welfare Organization, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-0053, Japan
| | - Yasuharu Nakashima
- Departments of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka, 812-8582, Japan
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17
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Soon EL, Leong AZ, Chiew J, Kaliya-Perumal AK, Yu CS, Oh JYL. Factors Impacting Mortality in Geriatric Patients with Acute Spine Fractures: A 12-Year Study of 613 Patients in Singapore. Asian Spine J 2019; 13:563-568. [PMID: 30866619 PMCID: PMC6680030 DOI: 10.31616/asj.2018.0231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/20/2018] [Indexed: 01/25/2023] Open
Abstract
Study Design Retrospective database analysis. Purpose To identify risk factors that predict mortality following acute spine fractures in geriatric patients of Singapore. Overview of Literature Acute geriatric spinal fractures contribute significantly to local healthcare costs and hospital admissions. However, geriatric mortality following acute spine fractures is scarcely assessed in the Asian population. Methods Electronic records of 3,010 patients who presented to our hospital’s emergency department and who were subsequently admitted during 2004–2015 with alleged history of traumatic spine fractures were retrospectively reviewed, and 613 patients (mean age, 85.7±4.5 years; range, 80–101 years; men, 108; women, 505) were shortlisted. Mortality rates were reviewed up to 1 year after admission and multivariate analyses were performed to identify independent risk factors correlating with mortality. Results Women were more susceptible to spine fractures (82.4%), with falls (77.8%) being the most common mechanism of injury. Mortality rates were 6.0%, 8.2%, and 10.4% at 3, 6, and 12 months, respectively. The most common causes of death at all 3 time points were pneumonia and ischemic heart disease. Based on the multivariate analysis at 1-year follow-up, elderly women had a lower mortality rate compared to men (p<0.001); mortality rates increased by 6.3% (p=0.024) for every 1-year increase in the patient’s age; and patients with an American Spinal Injury Association (ASIA) score of A–C had a much higher mortality rate compared to those with an ASIA score of D–E (p<0.001). Conclusions An older age at presentation, male sex, and an ASIA score of A–C were identified as independent factors predicting increased mortality among geriatric patients who sustained acute spine fractures. The study findings highlight at-risk groups for acute spine fractures, thereby providing an opportunity to develop strategies to increase the life expectancy of these patients.
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Affiliation(s)
- En Loong Soon
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Adriel Zhijie Leong
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Jean Chiew
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | | | - Chun Sing Yu
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
| | - Jacob Yoong-Leong Oh
- Division of Spine, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.,Lee Kong Chian School of Medicine, Singapore
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18
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Posillico SE, Golob JF, Rinker AD, Kreiner LA, West RS, Conrad-Schnetz KJ, Kelly ML, Claridge JA. Bedside dysphagia screens in patients with traumatic cervical injuries: An ideal tool for an under-recognized problem. J Trauma Acute Care Surg 2018; 85:697-703. [PMID: 30036259 DOI: 10.1097/ta.0000000000002035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We initiated a prospective interventional study using a nurse-driven bedside dysphagia screen (BDS) in patients with cervical spine injury (CI) to address three objectives: (1) determine the incidence of dysphagia, (2) determine the utility of the new BDS as a screening tool, and (3) compare patient outcomes, specifically dysphagia-related complications, in the study period with a retrospective cohort. METHODS All patients with CI admitted to a Level I trauma center were enrolled in a prospective 12-month study (June 2016-June 2017) and then were compared with a previous 18-month cohort of similar patients. Our new protocol mandated that every patient underwent a BDS before oral intake. If the patient failed the BDS, a modified barium swallow (MBS) was obtained. Exclusion criteria were emergency department discharge, inability to participate in a BDS, leaving against medical advice, BDS protocol violations, or death before BDS. A failed MBS was defined as a change in diet and a need for a repeat MBS. Dysphagia was defined as a failed MBS or the presence of a dysphagia-related complication. RESULTS Of 221 consecutive prospective patients identified, 114 met inclusion criteria. The incidence of dysphagia was 16.7% in all prospective study patients, 14.9% in patients with isolated CI, and 30.8% in patients with spinal cord injury. The BDS demonstrated 84.2% sensitivity, 95.8% specificity, 80.0% positive predictive value, and 96.8% negative predictive value. There were no dysphagia-related complications. The prospective study patients demonstrated significantly less dysphagia-related complications (p = 0.048) when compared with the retrospective cohort of 276 patients. CONCLUSIONS The introduction of the BDS resulted in increased dysphagia diagnoses, with a significant reduction in dysphagia-related complications. We recommend incorporating BDS into care pathways for patients with CI. LEVEL OF EVIDENCE Study type diagnostic test, level III.
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Affiliation(s)
- Sarah E Posillico
- From the Department of Surgery (S.E.P., J.F.G., A.D.R., L.A.K., K.J.C-S., J.A.C.), Speech and Language Pathology Services, Department of Rehabilitation, Physical Therapy, and Occupational Therapy (R.S.W.), and Department of Neurosurgery (M.L.K.), MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
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19
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Bank M, Gibbs K, Sison C, Kutub N, Paptheodorou A, Lee S, Stein A, Bloom O. Age and Other Risk Factors Influencing Long-Term Mortality in Patients With Traumatic Cervical Spine Fracture. Geriatr Orthop Surg Rehabil 2018; 9:2151459318770882. [PMID: 29760965 PMCID: PMC5946346 DOI: 10.1177/2151459318770882] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 11/16/2022] Open
Abstract
Objective To identify clinical or demographic variables that influence long-term mortality, as well as in-hospital mortality, with a particular focus on the effects of age. Summary and Background Data Cervical spine fractures with or without spinal cord injury (SCI) disproportionately impact the elderly who constitute an increasing percentage of the US population. Methods We analyzed data collected for 10 years at a state-designated level I trauma center to identify variables that influenced in-hospital and long-term mortality among elderly patients with traumatic cervical spine fracture with or without SCI. Acute in-hospital mortality was determined from hospital records and long-term mortality within the study period (2003-2013) was determined from the National Death Index. Univariate and multivariate regression analyses were used to identify factors influencing survival. Results Data from patients (N = 632) with cervical spine fractures were analyzed, the majority (66%) of whom were geriatric (older than age 64). Most patients (62%) had a mild/moderate injury severity score (ISS; median, interquartile range: 6, 5). Patients with SCI had significantly longer lengths of stay (14.1 days), days on a ventilator (3.5 days), and higher ISS (14.9) than patients without SCI (P < .0001 for all). Falls were the leading mechanism of injury for patients older than age 64. Univariate analysis identified that long-term survival decreased significantly for all patients older than age 65 (hazard ratio [HR]: 1.07; P < .0001). Multivariate analysis demonstrated age (HR: 1.08; P < .0001), gender (HR: 1.60; P < .0007), and SCI status (HR: 1.45, P < .02) significantly influenced survival during the study period. Conclusion This study identified age, gender, and SCI status as significant variables for this study population influencing long-term survival among patients with cervical spine fractures. Our results support the growing notion that cervical spine injuries in geriatric patients with trauma may warrant additional research.
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Affiliation(s)
- Matthew Bank
- Department of Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Katie Gibbs
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Physical Medicine and Rehabilitation, Northwell Health, Manhasset, NY, USA
| | - Cristina Sison
- Department of Biostatistics, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Nawshin Kutub
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Angelos Paptheodorou
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Samuel Lee
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Adam Stein
- Department of Physical Medicine and Rehabilitation, Northwell Health, Manhasset, NY, USA
| | - Ona Bloom
- Center for Autoimmune and Musculoskeletal Diseases, The Feinstein Institute for Medical Research, Manhasset, NY, USA.,Department of Physical Medicine and Rehabilitation, Northwell Health, Manhasset, NY, USA
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20
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Thesleff T, Niskakangas T, Luoto T, Iverson GL, Öhman J, Ronkainen A. Preventable diagnostic errors in fatal cervical spine injuries: a nationwide register-based study from 1987 to 2010. Spine J 2018; 18:430-438. [PMID: 28822822 DOI: 10.1016/j.spinee.2017.08.231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fall-induced injuries in patients are increasing in number, and they often lead to serious consequences, such as cervical spine injuries (CSI). CSI diagnostics remain a challenge despite improved radiological services. PURPOSE Our aim is to define the incidence and risk factors for diagnostic errors among patients who died following a CSI. STUDY DESIGN/SETTING A retrospective death certificate-based study of the whole population of Finland was carried out. PATIENT SAMPLE We identified 2,041 patients whose death was, according to the death certificate, either directly or indirectly caused by a CSI. OUTCOME MEASURES Demographics, injury- and death-related data, and adverse event (AE)-related data were the outcome measures. METHODS All death certificates between the years 1987 and 2010 from Statistics Finland that identified a CSI as a cause death were reviewed to identify preventable AEs with the emphasis on diagnostic errors. RESULTS Of the 2,041 patients with CSI-related deaths, 36.5% (n=744) survived at least until the next day. Errors in CSI diagnostics were found in 13.8% (n=103) of those who died later than the day of injury. Those with diagnostic errors were significantly older (median age 79.4 years, 95% confidence interval 75.9-80.1 vs. 74.9, 95% confidence interval 70.2-72.9, p<.001) and the mechanism of injury was significantly more often a fall (86.4%, n=89 vs. 69.7%, n=447, p=.002) compared with those who did not have a diagnostic error. The incidence of diagnostic errors increased slightly during the 24-year study period. CONCLUSIONS Cervical spine injury diagnostics remain difficult despite improved radiological services. The majority of the patients subjected to diagnostic errors are fragile elderly people with reduced physical capacity. In our analysis, preventable AEs and diagnostic errors were most commonly associated with ground-level falls.
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Affiliation(s)
- Tuomo Thesleff
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland.
| | - Tero Niskakangas
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Teemu Luoto
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Center for Health and Rehabilitation Research, 79/96 Thirteenth Street, Charlestown Navy Yard, Charlestown, MA, 02129, Massachusetts, USA
| | - Juha Öhman
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosciences and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland
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Ishak B, Schneider T, Gimmy V, Unterberg AW, Kiening KL. Early Complications, Morbidity, and Mortality in Octogenarians and Nonagenarians Undergoing Posterior Intra-Operative Spinal Navigation-Based C1/2 Fusion for Type II Odontoid Process Fractures. J Neurotrauma 2017. [DOI: 10.1089/neu.2017.4968] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Basem Ishak
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Till Schneider
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Valerie Gimmy
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Karl L. Kiening
- Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
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22
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Anterior Versus Posterior Approaches for Odontoid Fracture Stabilization in Patients Older Than 65 Years: 30-day Morbidity and Mortality in a National Database. Clin Spine Surg 2017; 30:E1033-E1038. [PMID: 27977443 DOI: 10.1097/bsd.0000000000000494] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE To compare 30-day perioperative clinical outcomes of surgical odontoid stabilization by an anterior or posterior operative approach in elderly patients. SUMMARY OF BACKGROUND DATA Surgical stabilization of odontoid fractures is superior to nonoperative management in geriatric patients. How elderly patients with odontoid fractures fare after anterior and posterior approaches, however, is not well defined. MATERIALS AND METHODS Retrospective review of the prospectively collected American College of Surgeons National Surgical Quality Improvement Program database (2005-2013). Elderly patients (≥65 y) with odontoid fractures who underwent odontoid stabilization through anterior or posterior approaches were identified by International Classification of Diseases 9th Revision/Common Procedure Terminology codes. Exclusion criteria included concomitant subaxial spine surgery, instrumentation noncontiguous with the atlantoaxial interval, and combined approaches. Baseline demographics and perioperative details were compared. Adverse events, mortality, reoperation, discharge, and readmission rates within 30 days of operation were compared using bivariate and multivariate generalized linear regressions. RESULTS One hundred forty-one patients (male-81; female-60; average age: 77.8±6.5 y; anterior approach-48; posterior approach-93) were analyzed. Patients scheduled to have a posterior approach had significantly more nonunions preoperatively and higher body mass indices. Operative times for posterior surgeries were significantly longer. Age, comorbidities, functional dependence, time to surgery, and length of hospital stay were similar between groups. There were no significant differences in the relative risk (RR) of the composite outcome of "any adverse event" after adjusting for differences in baseline characteristics. Patients who underwent an anterior approach were more likely to have an unplanned hospital readmission (RR=8.95; 95% confidence interval, 2.21-36.29; P=0.002) and have significantly more revision operations (RR=19.51; 95% confidence interval, 2.49-152.62; P=0.005) than patients who had a posterior operation. CONCLUSIONS An anterior approach for odontoid fracture stabilization in patients ≥65 years old were associated with shorter operative times and greater RRs of unplanned readmissions and revision operations within 30 days of surgery relative to a posterior approach.
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23
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Poole LM, Le P, Drake RM, Helmer SD, Haan JM. Analysis of patients ≥65 with predominant cervical spine fractures: Issues of disposition and dysphagia. J Emerg Trauma Shock 2017; 10:13-18. [PMID: 28243007 PMCID: PMC5316789 DOI: 10.4103/0974-2700.199518] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Cervical spine fractures occur in 2.6% to 4.7% of trauma patients aged 65 years or older. Mortality rates in this population ranges from 19% to 24%. A few studies have specifically looked at dysphagia in elderly patients with cervical spine injury. Aims: The aim of this study is to evaluate dysphagia, disposition, and mortality in elderly patients with cervical spine injury. Settings and Design: Retrospective review at an the American College of Surgeons-verified level 1 trauma center. Methods: Patients 65 years or older with cervical spine fracture, either isolated or in association with other minor injuries were included in the study. Data included demographics, injury details, neurologic deficits, dysphagia evaluation and treatment, hospitalization details, and outcomes. Statistical Analysis: Categorical and continuous data were analyzed using Chi-square analysis and one-way analysis of variance, respectively. Results: Of 136 patients in this study, 2 (1.5%) had a sensory deficit alone, 4 (2.9%) had a motor deficit alone, and 4 (2.9%) had a combined sensory and motor deficit. Nearly one-third of patients (n = 43, 31.6%) underwent formal swallow evaluation, and 4 (2.9%) had a nasogastric tube or Dobhoff tube placed for enteral nutrition, whereas eight others (5.9%) had a gastrostomy tube or percutaneous endoscopic gastrostomy tube placed. Most patients were discharged to a skilled nursing unit (n = 50, 36.8%), or to home or home with home health (n = 48, 35.3%). Seven patients (5.1%) died in the hospital, and eight more (5.9%) were transferred to hospice. Conclusion: Cervical spine injury in the elderly patient can lead to significant consequences, including dysphagia and need for skilled nursing care at discharge.
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Affiliation(s)
- Lisa M Poole
- Department of Surgery, The University of Kansas School of Medicine - Wichita, KS 67214, USA
| | - Phong Le
- Department of Surgery, The University of Kansas School of Medicine - Wichita, KS 67214, USA
| | - Rachel M Drake
- Department of Surgery, The University of Kansas School of Medicine - Wichita, KS 67214, USA
| | - Stephen D Helmer
- Department of Surgery, The University of Kansas School of Medicine - Wichita, KS 67214, USA; Department of Medical Education, Via Christi Hospital, Wichita, KS 67214, USA
| | - James M Haan
- Department of Surgery, The University of Kansas School of Medicine - Wichita, KS 67214, USA; Department of Trauma Services, Via Christi Hospital, Wichita, KS 67214, USA
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Khalilzadeh O, Rahimian M, Batchu V, Vadvala HV, Novelline RA, Choy G. Effectiveness of second-opinion radiology consultations to reassess the cervical spine CT scans: a study on trauma patients referred to a tertiary-care hospital. Diagn Interv Radiol 2016. [PMID: 26200483 DOI: 10.5152/dir.2015.15003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE A second opinion is a valuable resource in confirming proper medical diagnosis and treatment. This study evaluates the effectiveness of second-opinion radiology consultations to reassess the cervical spine computed tomography (CT) scans of the trauma patients referred to our hospital. METHODS Cervical spine CT scans of 301 consecutive adult trauma patients, who were referred to our hospital from outside institutions, were analyzed. The emergency radiologists at our institution completed the over-read reports on the CT images obtained at the outside facilities. A single radiologist compared the outside- and over-read reports and determined the discrepancy of the radiologic reports. RESULTS Based on the outside reports, 31% of the CT scans had cervical traumatic injury. In 92% of patients, the first-read and the over-read reports had consistent radiologic findings. About 90% of the positive, and 93% of the negative radiologic findings, were reported consistently in the over-read reports. Our analysis showed that the over-read reporting resulted in reassurance of negative findings in 63%; confirmation of positive findings in 29%; clearing a false diagnosis in 3%; and detection of a missed diagnosis in 5%. A rescan was done in 80% of patients with inconsistent and 20% of patients with consistent findings (P < 0.05). The most common missed radiologic findings in the first-reports were transverse and spinous process fractures and the most common misdiagnoses were dens fractures. CONCLUSION For a service offering second-opinion consultations on cervical spine trauma, review of outside CT studies improves diagnosis and benefits patient care.
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Affiliation(s)
- Omid Khalilzadeh
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
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Chen Y, Tang Y, Allen V, DeVivo MJ. Fall-induced spinal cord injury: External causes and implications for prevention. J Spinal Cord Med 2016; 39:24-31. [PMID: 25832327 PMCID: PMC4725788 DOI: 10.1179/2045772315y.0000000007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To document the demographic and clinical profile of persons who sustained spinal cord injury (SCI) as a result of accidental falls and to determine the usual circumstances surrounding the fall-induced SCI. DESIGN Cohort study. SETTING 21 SCI Model Systems centers throughout the United States. PARTICIPANTS 6,408 individuals with traumatic SCI between 2005 and 2014 were recruited from the National SCI Database. 1,877 (29%) of them were injuries caused by falls. INTERVENTIONS Not applicable. OUTCOMES MEASURES External causes of injury documented by the International Classification of Diseases, 10(th) revision, Clinical Modification (ICD-10-CM). RESULTS Falls on the same level from slipping, tripping, and stumbling were the most common cause of fall-induced SCI (20%), followed by falls from building (16%), stairs and steps (16%), and ladder (9%). People who were 61 years of age and older had the highest frequency of falls on the same level, while those aged 16-45 years had a higher percentage of falls from buildings, usually work-related. The mechanisms of falls also varied by sex and race. Associated injury and vertebral injury occurred frequently among falls from buildings and ladders. High falls were more likely to be work-related and result in thoracic and complete injury, while low falls were more commonly associated with cervical and motor functionally incomplete injury. CONCLUSION The study findings of different mechanisms of falls by age, sex, race and medical consequences provide an insight for future interventions aimed at high risk persons, activities, and environmental factors for preventing or reducing fall-induced SCI.
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Affiliation(s)
- Yuying Chen
- Department of Physical Medicine and Rehabilitation, Spain Rehabilitation Center, Birmingham, AL, USA,Correspondence to: Yuying Chen, 515 Spain Rehabilitation Center, 1717 6th Avenue South, Birmingham, AL 35249-7730, USA.
| | | | - Victoria Allen
- Department of Physical Medicine and Rehabilitation, Spain Rehabilitation Center, Birmingham, AL, USA
| | - Michael J DeVivo
- Department of Physical Medicine and Rehabilitation, Spain Rehabilitation Center, Birmingham, AL, USA
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Barmparas G, Cooper Z, Haider AH, Havens JM, Askari R, Salim A. The elderly patient with spinal injury: treat or transfer? J Surg Res 2015; 202:58-65. [PMID: 27083948 DOI: 10.1016/j.jss.2015.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 11/23/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The purpose of this investigation was to delineate whether elderly patients with spinal injuries benefit from transfers to higher level trauma centers. METHODS Retrospective review of the National Trauma Data Bank 2007 to 2011, including patients > 65 (y) with any spinal fracture and/or spinal cord injury from a blunt mechanism. Patients who were transferred to level I and II centers from other facilities were compared to those admitted and received their definitive treatment at level III or other centers. RESULTS Of 3,313,117 eligible patients, 43,637 (1.3%) met inclusion criteria: 19,588 (44.9%) were transferred to level I-II centers, and 24,049 (55.1%) received definitive treatment at level III or other centers. Most of the patients (95.8%) had a spinal fracture without a spinal cord injury. Transferred patients were more likely to require an intensive care unit admission (48.5% versus 36.0%, P < 0.001) and ventilatory support (16.1% versus 13.3%, P < 0.001). Mortality for the entire cohort was 7.7% (8.6% versus 7.1%, P < 0.001) and significantly higher, at 21.7% for patients with a spinal cord injury (22.3% versus 21.0%, P < 0.001). After adjusting for all available covariates, there was no difference in the adjusted mortality between patients transferred to higher level centers and those treated at lower level centers (adjusted odds ratio [95% confidence interval]: 1.05 [0.95-1.17], P = 0.325). CONCLUSIONS Transfer of elderly patients with spinal injuries to higher level trauma centers is not associated with improved survival. Future studies should explore the justifications used for these transfers and focus on other outcome measures such as functional status to determine the potential benefit from such practices.
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Affiliation(s)
- Galinos Barmparas
- Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Zara Cooper
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Adil H Haider
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joaquim M Havens
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Reza Askari
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ali Salim
- Department of Surgery, Division of Trauma, Burn, and Surgical Critical Care, Brigham and Women's Hospital, Boston, Massachusetts
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Abstract
INTRODUCTION Longer-term outcomes of patients with geriatric type II odontoid fracture nonunion remain unclear. METHODS Thirty-four consecutive geriatric patients (>70 years old) with minimally displaced (<50% displacement) type II odontoid fractures were treated 24 hours a day for 12 weeks with rigid collar immobilization between the years 2003 and 2011. Radiographic and medical record reviews were performed on all 34 patients. Additionally, 7 patients were available for clinical longer-term follow-up (>4 years). RESULTS In all, 30 (88%) of the 34 patients had nonunion after 12 weeks of treatment, 2 (6%) patients had union, and 2 (6%) patients died during the first 12 weeks. Twenty-one of the 30 patients with nonunion had a displaced or mobile nonunion (70%), and 4 (12%) patients were lost to follow-up. At longer-term follow-up, 23 (68%) patients had died. The average time death occurred was 3.8 years with a range of 0.17 years to 9.42 years postinjury. Twenty of the 23 deaths were attributed to medical comorbidities not related to the patient's odontoid nonunion. We were unable to determine the cause of death in 3 patients. None of the patients who died had identifiable clinical myelopathy prior to their death on chart review. Of the 7 patients who were alive, all were determined to have odontoid nonunion, of which 5 (70%) were mobile odontoid nonunion. Visual Analog Scale (VAS) and Neck Disability Index (NDI) scores were low (VAS averaged 0.57 and NDI averaged 6.9%) and treatment satisfaction was high (averaged 9.7 of 10). Scores for pain and function did not differ significantly when compared to age-matched controls (P = .08, t test). CONCLUSION Rates of odontoid nonunion are high in patients with geriatric odontoid fractures that are treated with continuous rigid collar for 12 weeks. The majority of patients with nonunion appear to achieve high functional outcomes. In this study, mortality did not appear to be related to adverse neurologic events after treatment.
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Affiliation(s)
- Brandon Raudenbush
- Department of Orthopaedics, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY, USA
| | - Robert Molinari
- Department of Orthopaedics, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY, USA
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Korhonen N, Kannus P, Niemi S, Parkkari J, Sievänen H. Rapid increase in fall-induced cervical spine injuries among older Finnish adults between 1970 and 2011. Age Ageing 2014; 43:567-71. [PMID: 24865165 DOI: 10.1093/ageing/afu060] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND fall-related injuries in older adults are a major public heath challenge. METHODS we determined the current trends in the number and age-adjusted incidence of fall-induced severe cervical spine injuries among older adults in Finland by taking into account all persons in 50 years of age or older who were admitted to Finnish hospitals for primary treatment of these injuries between 1970 and 2011. Similar patients aged 20-49 years served as a reference group. RESULTS the number of fall-induced cervical spine injuries among older Finns rose six-fold from 59 in 1970 to 372 in 2011. The age-adjusted incidence of injury (per 100 000 persons) was higher in men than in women throughout this period and showed a clear increase from 1970 to 2011: from 8.5 to 20.3 in men, and from 2.8 to 11.7 in women. In both sexes, the increase was most prominent in the oldest age group, persons aged 70 years or older. In the reference group, the injury incidence did not rise by time. CONCLUSIONS the number and incidence of fall-induced severe cervical spine injuries among older Finns increased considerably between 1970 and 2011. An increase in the average risk of serious falls may partly explain the phenomenon. Wide-scale fall and injury prevention measures are urgently needed, because further ageing of the population is likely to worsen the problem in the near future.
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Affiliation(s)
- Niina Korhonen
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Pekka Kannus
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Seppo Niemi
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Jari Parkkari
- Tampere Research Center of Sports Medicine, UKK Institute for Health Promotion Research, Tampere, Finland
| | - Harri Sievänen
- Injury and Osteoporosis Research Center, UKK Institute for Health Promotion Research, Tampere, Finland
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Mitchell RJ, Stanford R, McVeigh C, Bell D, Close JCT. Incidence, circumstances, treatment and outcome of high-level cervical spinal fracture without associated spinal cord injury in New South Wales, Australia over a 12 year period. Injury 2014; 45:217-22. [PMID: 23570702 DOI: 10.1016/j.injury.2013.02.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/31/2013] [Accepted: 02/22/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND No Australian population-based studies have examined temporal trends in the incidence of fracture of the first or second cervical vertebra (C1 or C2 fractures), their aetiology, treatment and outcome for younger (15-64 years) compared to older (65+ years) individuals. The aim of this research is to examine the circumstances, treatment and outcomes including mortality for C1 or C2 fractures without associated spinal cord injury by age group in New South Wales (NSW), Australia. METHOD A retrospective review of C1 or C2 vertebra fractures in individuals aged 15 years and over in the NSW Admitted Patient Data Collection from 1 July 1998 to 30 June 2010. Direct age standardised admission rates were calculated by cervical fracture type and by age group. Negative binomial regression was used to examine the statistical significance of changes in trend over time of hospitalised cervical fractures by age group. RESULTS The annual rate of hospitalised C1 and C2 fractures without associated spinal cord injury for individuals aged 15 years and over in NSW was 2.3 per 100,000 population, with the rate estimated to increase by 5.3% each year. Those aged 85+ years had the highest rates of hospitalisation. For those aged 15-64 years, road trauma was the most common mechanism of injury, while for those aged 65+ years, a fall was the dominant mechanism of injury. The in-hospital mortality for individuals aged 65+ years was 11.8% compared to 0.7% for those aged 15-64 years. CONCLUSIONS This study identified an estimated increasing trend in C1 and C2 fractures over time, particularly for older individuals. While younger individuals are commonly injured in road traffic accidents, older individuals are predominantly injured following a fall. Injury prevention strategies should be targeted to the different age groups and injury mechanisms. Implementation of effective falls prevention strategies is likely to reduce these injuries in older people whilst road and vehicle safety including vehicle rollover protection standards may improve rates in younger people.
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Affiliation(s)
- Rebecca J Mitchell
- Falls and Injury Prevention Group, Neuroscience Research Australia,, Australia.
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Kohlhof H, Seidel U, Hoppe S, Keel MJ, Benneker LM. Cement-augmented anterior screw fixation of Type II odontoid fractures in elderly patients with osteoporosis. Spine J 2013; 13:1858-63. [PMID: 23993037 DOI: 10.1016/j.spinee.2013.06.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Revised: 05/27/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Closed reduction and internal fixation by an anterior approach is an established option for operative treatment of displaced Type II odontoid fractures. In elderly patients, however, inadequate screw purchase in osteoporotic bone can result in severe procedure-related complications. PURPOSE To improve the stability of odontoid fracture screw fixation in the elderly using a new technique that includes injection of polymethylmethacrylat (PMMA) cement into the C2 body. STUDY DESIGN Retrospective review of hospital and outpatient records as well as radiographs of elderly patients treated in a university hospital department of orthopedic surgery. PATIENT SAMPLE Twenty-four elderly patients (8 males and 16 females; mean age, 81 years; range, 62-98 years) with Type II fractures of the dens. OUTCOME MEASURES Complications, cement leakage (symptomatic/asymptomatic), operation time, loss of reduction, pseudarthrosis and revision surgery, patient complaints, return to normal activities, and signs of neurologic complications were all documented. METHODS After closed reduction and anterior approach to the inferior border of C2, a guide wire is advanced to the tip of the odontoid under biplanar fluoroscopic control. Before the insertion of one cannulated, self-drilling, short thread screws, a 12 gauge Yamshidi cannula is inserted from anterior and 1 to 3 mL of high-viscosity PMMA cement is injected into the anteroinferior portion of the C2 body. During polymerization of the cement, the screws are further inserted using a lag-screw compression technique. The cervical spine then is immobilized with a soft collar for 8 weeks postoperatively. RESULTS Anatomical reduction of the dens was achieved in all 24 patients. Mean operative time was 64 minutes (40-90 minutes). Early loss of reduction occurred in three patients, but revision surgery was indicated in only one patient 2 days after primary surgery. One patient died within the first eight postoperative weeks, one within 3 months after surgery. In five patients, asymptomatic cement leakage was observed (into the C1-C2 joint in three patients, into the fracture in two). Conventional radiologic follow-up at 2 and 6 months confirmed anatomical healing in 16 of the 19 patients with complete follow-up. In two patients, the fractures healed in slight dorsal angulation; one patient developed a asymptomatic pseudarthrosis. All patients were able to resume their pretrauma level of activity. CONCLUSIONS Cement augmentation of the screw in Type II odontoid fractures in elderly patients is technically feasible in a clinical setting with a low complication rate. This technique may improve screw purchase, especially in the osteoporotic C2 body.
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Affiliation(s)
- Hendrik Kohlhof
- Department of Orthopedic Surgery and Traumatology, Inselspital, University Hospital of Berne, 3010 Bern, Switzerland; Department of Orthopedic Surgery and Traumatology, University and University Hospitals of Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
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The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976) 2013; 38:1098-104. [PMID: 23354104 PMCID: PMC3678887 DOI: 10.1097/brs.0b013e318286f0cf] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective, multicenter cohort study. OBJECTIVE Assess for differences in short- and long-term mortality between operative and nonoperative treatment for elderly patients with type II odontoid fractures. SUMMARY OF BACKGROUND DATA There is controversy regarding whether operative or nonoperative management is the best treatment for elderly patients with type II odontoid fractures. METHODS This is a retrospective study of consecutive patients aged 65 years or older with type II odontoid fracture from 3 level I trauma centers from 2003-2009. Demographics, comorbidities, and treatment were abstracted from medical records. Mortality outcomes were obtained from medical records and a public database. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated. RESULTS A total of 322 patients were included (mean age, 81.8 yr; range, 65.0-101.5 yr). Compared with patients treated nonoperatively (n = 157), patients treated operatively (n = 165) were slightly younger (80.4 vs. 83.2 yr, P = 0.0014), had a longer hospital (15.0 vs. 7.4 d, P < 0.001) and intensive care unit (1.5 vs. 1.1 d, P = 0.008) stay, and were more likely to receive a feeding tube (18% vs. 5%, P = 0.0003). Operative and nonoperative treatment groups had similar sex distribution (P = 0.94) and Charlson comorbidity index (P = 0.11). Within 30 days of presentation, 14% of patients died, and at maximal follow-up (average = 2.05 yr; range = 0 d-7.02 yr), 44% had died. On multivariate analysis, nonoperative treatment was associated with higher 30-day mortality (HR = 3.00, 95% CI = 1.51-5.94, P = 0.0017), after adjusting for age (HR = 1.10, 95% CI = 1.05-1.14; P < 0.0001), male sex (P = 0.69), and Charlson comorbidity index (P = 0.16). At maximal follow-up, there was a trend toward higher mortality associated with nonoperative treatment (HR = 1.35, 95% CI = 0.97-1.89, P = 0.079), after adjusting for age (HR = 1.07, 95% CI = 1.05-1.10; P < 0.0001), male sex (HR = 1.55, 95% CI = 1.10-2.16; P = 0.012), and Charlson comorbidity index (HR = 1.28, 95% CI = 1.16-1.40; P < 0.0001). CONCLUSION Surgical treatment of type II odontoid fracture in this elderly population did not negatively impact survival, even after adjusting for age, sex, and comorbidities. The data suggest a significant 30-day survival advantage and a trend toward improved longer-term survival for operatively treated over nonoperatively treated patients. LEVEL OF EVIDENCE 4.
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Predictors for mortality in elderly patients with cervical spine injury: a systematic methodological review. Spine (Phila Pa 1976) 2013; 38:770-7. [PMID: 23124263 DOI: 10.1097/brs.0b013e31827ab317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Kennedy P, Cox A, Mariani A. Spinal cord injuries as a consequence of falls: are there differential rehabilitation outcomes? Spinal Cord 2012; 51:209-13. [DOI: 10.1038/sc.2012.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Current concepts in the treatment of Anderson Type II odontoid fractures in the elderly in Germany, Austria and Switzerland. Injury 2012; 43:462-9. [PMID: 22001503 DOI: 10.1016/j.injury.2011.09.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 09/23/2011] [Accepted: 09/26/2011] [Indexed: 02/02/2023]
Abstract
Although currently there are many different recommendations and strategies in the therapy of odontoid fractures in the elderly, there are still no generally accepted guidelines for a structured and standardised treatment. Moreover, the current opinion of spine surgeons regarding the optimal treatment of odontoid fractures Type II of the elderly is unknown. In order to have an objective insight into the diverging strategies for the management of Anderson Type II odontoid fractures and form a basis for future comparisons, this study investigated the current concepts and preferences of orthopaedic, neuro- and trauma surgeons. Spine surgeons from 34 medical schools and 8 hospitals in Germany, 4 university hospitals in Austria and 5 in Switzerland were invited to participate in an online survey using a 12-item 1-sided questionnaire. A total of 44 interviewees from 34 medical institutions participated in the survey, consisting of trauma (50%), orthopaedic (20.5%) and neurosurgeons (27.3%). Out of these, 70.5% treated 1-20 fractures per year; 63.6% favoured the anterior screw fixation as therapy for Type II odontoid fractures, the open posterior Magerl transarticular C1/C2 fusion, the posterior Harms C1/C2 fusion, and conservative immobilisation by cervical orthosis was preferred by 9.1% in each case. 59.1% preferred the anterior odontoid screw fixation as an appropriate treatment of Anderson Type II odontoid fractures in the elderly. 79.5% chose cervical orthosis for postsurgical treatment. Following operative treatment, nonunion rates were reported to be <10% and <20% by 40.9% and 70% of the surgeons, respectively. 56.8% reported changing from primary conservative to secondary operative treatment in <10% of cases. The most favoured technique in revision surgery of nonunions was the open posterior Magerl transarticular fusion technique, chosen by 38.6% of respondents. 18.2% preferred the posterior Harms C1/C2 fusion technique, 11.4% the percutaneous posterior Magerl technique and the anterior odontoid screw fixation in each case. This study discovered major variations in the treatment of Anderson Type II odontoid fractures in the elderly in terms of indication for conservative and operative treatment between several treatment centres in 3 European countries. Difficulty and complexity in formulating general guidelines based on multicenter studies is conceivable.
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Type II odontoid fractures of the cervical spine: do treatment type and medical comorbidities affect mortality in elderly patients? Spine (Phila Pa 1976) 2011; 36:879-85. [PMID: 21217435 PMCID: PMC3261514 DOI: 10.1097/brs.0b013e3181e8e77c] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the influence of age, comorbidities, and treatment type on mortality in elderly patients with acute Type II odontoid fractures. SUMMARY OF BACKGROUND DATA Prior studies have documented increased morbidity and mortality among geriatric patients sustaining odontoid fractures. However, there is limited data regarding the effect of patient age, medical comorbidities, and treatment selection on mortality after Type II odontoid (C2) fractures in the elderly. METHODS An institutional registry was used to identify all Type II odontoid fractures sustained by patients aged 65 and older from 1991 to 2006. Demographic information, date of injury, associated injuries, treatment type, and comorbidities were abstracted from medical records. Mortality was ascertained using the National Death Index. Risks of mortality and their associated 95% confidence intervals (CIs) were calculated at 3 months, 1 year, 2 years, and 3 years. Multivariable Cox proportional hazard regression was used to evaluate independent factors affecting mortality stratified by age (65-74 years, 75-84 years, ≥ 85 years) and treatment type (operative or nonoperative treatment, and halo or collar immobilization). RESULTS Of 156 patients identified with Type II odontoid fracture, the average age was 82 years (SD = 7.8; Range: 65-101). One hundred and twelve patients (72%) were treated nonoperatively. At 3 years postinjury, there was a 39% (95% CI: 32-47) mortality rate for the entire cohort. Mortality for the operative group was 11% (95% CI: 2-21) at 3 months and 21% (95% CI: 9-32) at 1 year compared with 25% (95% CI: 17-33) at 3 months and 36% (95% CI: 27-45) at 1 year in the nonoperative group. The Cox regression model showed that the protective effect of surgery was seen in patients aged 65 to 74 years, in whom the hazard ratio associated with surgery for mortality after odontoid fracture was 0.4 (95% CI: 0.1-1.5). Those aged 75 to 84 years had a hazard ratio of 0.8 (95% CI: 0.3-2.3), and patients 85 years or older had a hazard ratio of 1.9 (95% CI: 0.6-6.1; P value for interaction between age and treatment = 0.09) with operative treatment having a protective effect in patients aged 65 to 74 years. CONCLUSION In a cohort of elderly patients, Type II odontoid fractures were associated with a high rate of mortality, regardless of intervention.
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Schoenfeld AJ, Harris MB, McGuire KJ, Warholic N, Wood KB, Bono CM. Mortality in elderly patients with hyperostotic disease of the cervical spine after fracture: an age- and sex-matched study. Spine J 2011; 11:257-64. [PMID: 21377938 DOI: 10.1016/j.spinee.2011.01.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 12/27/2010] [Accepted: 01/26/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Several reports indicate that patients with ankylosing spondylitis (AS) and diffuse idiopathic skeletal hyperostosis (DISH) have increased mortality after cervical spine fractures. However, outcomes of the fractured hyperostotic cervical spine are incompletely described, and there are limited data regarding the covariable effects of patient age and medical comorbidities on mortality. PURPOSE To determine mortality associated with cervical fractures in patients with hyperostotic disease. STUDY DESIGN Retrospective case-control study. PATIENT SAMPLE Forty-three patients identified through a registry as having fractures of the cervical spine in the setting of hyperostotic disease. These patients were matched to 43 controls who did not carry the diagnosis of hyperostotic disease. OUTCOME MEASURES Mortality at 3 months and 1, 2, and 3 years after fracture. METHODS An institutional database was used to identify all cervical fractures sustained by patients aged 65 years and older from 1991 to 2006. Demographic information, date of injury, associated injuries, treatment type, presence of AS or DISH, and comorbidities were abstracted from medical records and radiographs. Mortality was ascertained using the National Death Index. Patients with AS or DISH were matched to controls who did not carry the diagnosis of hyperostotic disease. Risks of mortality were calculated at 3 months, 1 year, 2 years, and 3 years. Kaplan-Meier methods, logistic regression analysis, the two independent sample t test, and the Fisher exact test were used to compare mortalities between the two groups. Statistical significance was determined as p values <.05. RESULTS Forty-three patients were identified as having fractures in the setting of hyperostotic disease of the cervical spine. Twenty-seven individuals had DISH, and 16 had AS. The average age of both the study group and controls was 80 years, with an age range of 68 to 94. There was no significantly increased risk of mortality between the overall study group and control group at 3 months (p=.20), 1 (p=.22), 2 (p=.15), or 3 years (p=.50) after injury. Compared with controls, subgroup analysis of patients with AS showed a statistically increased risk of mortality at 3 months (p<.01) and at 1 and 2 years (p<.01 at both time points). When compared with individuals with DISH, those with AS had an increased risk of mortality at time points up to 2 years after fracture. Patients with DISH did not have an increased mortality risk at any time point when compared with controls. CONCLUSIONS The effect of fracture on mortality appears to be greatest in those with AS. Patients with DISH did not demonstrate an increased risk of mortality compared with age- and sex-matched controls. Future studies of patients with hyperostotic disease should analyze patients with DISH and AS separately instead of as a single homogenous group. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Andrew J Schoenfeld
- Department of Orthopaedic Surgery, William Beaumont Army Medical Center, Texas Tech University Health Sciences Center, 5005 N. Piedras St, El Paso, TX 79920, USA.
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Butler T, Shin S, Collins J, Britt RC, Reed SF, Weireter LJ, Britt LD. Cervical Spinal Cord Injury Associated with Near-Drowning Does Not Increase Pneumonia Risk or Mortality. Am Surg 2011. [DOI: 10.1177/000313481107700417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Body surfing accidents (BSA) can cause cervical spinal cord injuries (CSCIs) that are associated with near-drowning (ND). The submersion injury from a ND can result in aspiration and predispose to pulmonary complications. We predicted a worse outcome (particularly the development of pneumonia) in patients with CSCIs associated with ND. A retrospective review was performed of patients who were treated at Eastern Virginia Medical School for a CSCI resulting from a blunt mechanism. Data collected included basic demographic data, data regarding injury and in-hospital outcomes, and discharge data, including discharge disposition. Statistics were performed using χ2 and Student t test. In 2003 to 2008, 141 patients were treated for CSCIs with inclusion criteria. Thirty patients (21%) had an associated ND (BSA) and 111 patients (79%) did not (BLT). The cohorts were similar in mean age (BSA, 45 years; BLT, 50 years; P = 0.16) and male gender distribution (BSA, 93%; BLT, 79%; P = 0.13). The cohorts were similar in injury severity using Injury Severity Score (BSA, 22; BLT, 24; P = 0.65). The cohorts were similar in rates of developing pneumonia (BSA, 3%; BLT, 12%; P = 0.31). The rate of infection was significantly higher in the cohort without an associated near-drowning (BSA, 10%; BLT, 32%; P = 0.033). The mean intensive care unit stay (BSA, 3.5 days; BLT, 11.3 days; P = 0.057) and the rate of mortality were similar (BSA, 10%; BLT, 10% P = 0.99). Those patients with an associated ND had a shorter hospital stay (BSA, 5.7 days; BLT, 22.2 days; P = 0.007) and a better chance of being discharged home (BSA, 57%; BLT, 27%; P = 0.004). CSCIs after a BSA do better than their counterparts without an associated ND. CSCIs associated with ND appear to be isolated injuries with minimal pulmonary involvement despite submersion injuries.
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Affiliation(s)
- Thomas Butler
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Susanna Shin
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Jay Collins
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Rebecca C. Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | - Scott F. Reed
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
| | | | - L. D. Britt
- Department of Surgery, Eastern Virginia Medical School, Norfolk, Virginia
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Methodological systematic review: mortality in elderly patients with cervical spine injury: a critical appraisal of the reporting of baseline characteristics, follow-up, cause of death, and analysis of risk factors. Spine (Phila Pa 1976) 2010; 35:1079-87. [PMID: 20393400 DOI: 10.1097/brs.0b013e3181bc9fd2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Methodologic systematic review. OBJECTIVE To determine the validity of reported risk factors for mortality in elderly patients with cervical spine injury. SUMMARY OF BACKGROUND DATA In elderly patients with cervical spine injury, mortality has frequently been associated with the type of treatment. To date, however, no review evaluating the validity of reported risk factors for mortality in elderly patients with cervical spine injury has been published. METHODS Studies evaluating the treatment of cervical spine injuries in elderly (>/=60 years of age) patients were searched through the Medline and EMBASE databases. In addition to standard methodologic details, reporting of putative confounding baseline characteristics and analysis of risk factors for mortality were appraised critically. For this purpose, patient data presented in included studies were pooled. Exploratory descriptive statistics were used for data analysis. RESULTS Twenty-six eligible studies were identified, including a total of 1550 pooled elderly subjects. Except for 2, all studies reported presence or absence of spinal cord injury. Details concerning the severity and/or extent of the injury were reported in 12 (46%) studies. Pre-existing comorbidities were reported in 9 studies (35%). In the pooled subjects, the cause of death was not reported in 155 of 335 deceased patients (42%). Based on own results, 18 (69%) studies reported on risk factors for mortality. Of these studies, 6 (23%) performed statistical analyses of risk factors for mortality outcomes. Only 1 study statistically adjusted potential risk factors for mortality for confounding. CONCLUSION Overall, pre-existing comorbidities, concomitant injuries, follow-up and cause of death have been underreported in studies investigating the treatment of cervical spine injuries in elderly patients. To strengthen the validity of risk factors for mortality in future clinical trials, adjustments for appropriately reported putative confounders by regression analysis are mandatory.
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Abstract
STUDY DESIGN Systematic analysis. OBJECTIVE To determine the morbidity and mortality of surgical treatment of odontoid fractures in the elderly. SUMMARY OF BACKGROUND DATA The prevalence of trauma in the elderly is increasing. There exists no consensus regarding the role of surgical treatment for odontoid fractures in the elderly and there exists significant variability in clinical practice. This variability may be related to a lack of robust information available to clinicians. Importantly, studies that define surgical risk are not available. METHODS A systematic analysis of the English language literature was undertaken for articles published between January 1990 and June 2009. Electronic databases and reference lists of key articles were searched to identify articles examining complications and mortality following odontoid fracture surgery in subjects 65 years of age or older. Two independent reviewers assessed the level of evidence quality using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria, and disagreements were resolved by consensus. RESULTS The initial literature search yielded 247 articles related to morbidity or mortality following surgery treatment of odontoid fractures in the elderly. After exclusion of articles based on title or abstract information, 48 remained to undergo full text review. Subsequent exclusions yielded 14 articles suited for this analysis. The most commonly reported major complications after odontoid fracture surgery in the elderly include cardiac failure (6.8%), DVT (3.2%), stroke (3.2%), pneumonia (9.9%), respiratory failure (7.7%), liver failure (6.7%), and severe infection (3.2%). Other site specific and minor complications were found to be reported consistently in the literature. The overall mortality rate after surgery is 10.1% (in-hospital, 6.2%; postdischarge, 8.8%). Similar mortality rates were found following anterior surgery (7% in-hospital; 9% overall) and posterior surgery (8% in-hospital; 9% overall); there were no differences in the rate of major airway complications between these groups (anterior: 17%; posterior: 18%). There was, however, a higher rate of site-specific complications, including nonunion, technical failure, and the need for revision surgery, following anterior surgery as compared with posterior surgery. CONCLUSION Based on the summary of criteria results, future research evaluating complications following surgery for odontoid fractures in elderly patients is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate currently available in the literature.
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Harris MB, Reichmann WM, Bono CM, Bouchard K, Corbett KL, Warholic N, Simon JB, Schoenfeld AJ, Maciolek L, Corsello P, Losina E, Katz JN. Mortality in elderly patients after cervical spine fractures. J Bone Joint Surg Am 2010; 92:567-74. [PMID: 20194314 PMCID: PMC2827825 DOI: 10.2106/jbjs.i.00003] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- Mitchel B. Harris
- 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:
| | - William M. Reichmann
- 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:
| | - Christopher M. Bono
- 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:
| | - Kim Bouchard
- 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:
| | - Kelly L. Corbett
- 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:
| | - Natalie Warholic
- 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:
| | - Josef B. Simon
- 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:
| | - Andrew J. Schoenfeld
- 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:
| | - Lawrence Maciolek
- 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:
| | - Paul Corsello
- 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:
| | - Elena Losina
- 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:
| | - Jeffrey N. Katz
- 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:
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Abstract
SummaryMajor traumatic injury is a leading cause of death in younger age groups, but increasingly older people are affected also. Adverse outcomes, both physical and psychological, are associated with injury in the older population. This review aims to locate and describe the evidence relating to older people and major trauma in order to inform policy, practice, research and education. The published research and systematic reviews fall into three main topics: mechanism of traumatic injury in older people, the effects of co-morbidities on older trauma patients and outcomes following serious traumatic injury in older people. The psychological impact of traumatic injury and the resulting functional alteration cannot be underestimated in this group of patients.
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Gonzalez-Beicos A, Nunez DB. Role of multidetector computed tomography in the assessment of cervical spine trauma. Semin Ultrasound CT MR 2009; 30:159-67. [PMID: 19537047 DOI: 10.1053/j.sult.2009.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clearing the cervical spine has relied on individual and center-based experience. Not long ago, the screening modality of choice was radiography. The evidence now clearly supports multidetector computed tomography as the modality of choice for evaluating cervical spine trauma because of its higher accuracy and efficiency compared to radiography. Furthermore, clinical criteria have been validated to assess for cervical spine injuries and determine the need for imaging evaluation based on patient risk. Once imaging is deemed necessary to exclude cervical spine injury based on clinical predictors, multidetector computed tomography becomes the accepted modality of choice, providing accurate and rapid assessment and improving the understanding of injury patterns and stability determinants.
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Affiliation(s)
- Aldo Gonzalez-Beicos
- Radiology Department, Hospital of Saint Raphael, Yale University School of Medicine, 1450 Chapel St., New Haven, CT 06511, USA.
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