Upper cervical trauma yielded higher complication, mortality rates vs subaxial trauma
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Although patients with upper cervical spine trauma had less severe injuries, they had higher risks of mortality and medical and surgical complications compared with patients with subaxial spine trauma, according to results.
Hunter Waddell, MD, and colleagues collected patient and injury characteristics, complications and mortality rates of 922 patients older than 65 years who presented with either upper cervical trauma (n=545) or subaxial trauma (n=377) between 2010 and 2018.
“With regard to patient characteristics, the patients with upper cervical trauma were significantly older,” Waddell said in his presentation at the North American Spina Society Annual Meeting. “In addition, patients with upper cervical trauma had significantly lower Psoas indexes and L3 Hounsfield units, indicating higher rate of sarcopenia and osteopenia. Patients with upper cervical trauma also had significantly higher rates of dementia.”
While patients with upper cervical trauma and subaxial trauma had no significant differences in rates of cardiac or pulmonary comorbidities, Waddell noted patients with subaxial trauma had more severe injuries and a higher injury severity score. Waddell added patients with subaxial trauma also had non-contiguous multilevel spine trauma, as well as pelvic fractures and closed head injuries.
“Patients with subaxial spine trauma had significantly longer hospital stays,” Waddell said. “There was also a significant difference in the number of patients that were treated operatively.”
Results showed patients with upper cervical trauma had a higher mortality rate during the study period. However, no differences were found in in-hospital mortality between the two groups, according to Waddell. Among patients treated operatively, Waddell noted patients in the upper cervical cohort had a significantly higher rate of all-cause complications. In particular, he said patients in the upper cervical group had a significantly higher rate of pneumonia.
“In the upper cervical cohort, there was no significant difference in the mortality in-house when compared operative vs. nonoperative treatment,” Waddell said.
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Waddell WH, et al. Paper 260. Presented at: North American Spine Society Annual Meeting; Sept. 29 - Oct. 2, 2021; Boston (hybrid meeting).
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