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

World Neurosurg. 2018 Dec;120:e114-e130. doi: 10.1016/j.wneu.2018.07.228. Epub 2018 Aug 2.


Background: Cervical spine (C-spine) injuries cause significant morbidity and mortality among elderly patients. Although the population of older-adults ≥65 years in the United States is expanding, estimates of the burden and outcome of C-spine injury are lacking.

Methods: The Nationwide Inpatient Sample 2001-2010 was analyzed. International Classification of Diseases, Ninth Revision, Clinical Modification codes identified patients with isolated C-spine fractures (ICF) and C-spine fractures with spinal cord injury (CSCI). Annual admission and mortality rates were calculated using U.S. Census data.

Results: A total of 167,278 older adults were included. Median age was 81 years (interquartile range = 74-86). Most patients were female (54.9%), had Medicare coverage (77.6%), were treated in teaching hospitals (63.2%), and had falls as the leading injury mechanism (51.2%). ICF occurred in 91.3%, whereas CSCI occurred in 8.7% (P < 0.001). ICF was more common in ≥85-year-old patients and CSCI in 65- to 69-year-old patients (P < 0.001). The most common injured C-spine level in ICF was the C2 level (47.6%, P < 0.001) and in CSCI was C1-C4 level (4.5%, P < 0.001). Overall, 15.8% underwent C-spine surgery. Hospitalization rates increased from 26/100,000 in 2001 to 68/100,000 in 2010 (∼167% change, P < 0.001). Correspondingly, overall mortality increased from 3/100,000 in 2001 to 6/100,000 in 2010, P < 0.001. In-hospital mortality was 11.3%, was strongly associated with increasing age and CSCI (P < 0.001).

Conclusions: In summary, C-spine fractures among U.S. older adults constitute a significant health care burden. ICFs occur commonly, C2-vertebra fractures are most frequent, whereas CSCIs are linked to increased hospital-resource use and worse outcomes. The incidence of C-spine fractures and mortality more than doubled over the past decade; however, proportional in-hospital mortality is decreasing.

Keywords: Cervical spine fractures; Cervical spine surgery; Elderly; Isolated spinal cord injury; Mortality; Odontoid.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cervical Vertebrae / injuries*
  • Female
  • Hospital Charges*
  • Humans
  • Incidence
  • Male
  • Mortality / trends
  • Sex Distribution
  • Spinal Cord Injuries / economics
  • Spinal Cord Injuries / epidemiology*
  • Spinal Cord Injuries / mortality
  • Spinal Fractures / economics
  • Spinal Fractures / epidemiology*
  • Spinal Fractures / mortality
  • United States / epidemiology