A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients

Takeshi Sasagawa ,Shota Ikegami ,Gen Inoue ,Munehiro Sakata ,Akihiro Yamaji ,Masashi Miyazaki ,Yoichi Iizuka ,Masayuki Ishihara ,Fumihiko Eto ,Takeo Furuya ,Kohei Kawaguchi ,Yohei Haruta ,Yasushi Oshima ,Kazuki Takeda ,Seiji Ohtori ,Tomohiko Hasegawa ,Kazuhito Hashimoto ,Shoji Seki ,Mariko Uehara ,Tomohiro Yamada ,Kazuo Nakanishi ,Hiroyuki Hayashi ,Hirokatsu Sawada ,Yasuaki Imajo ,Kosuke Misaki ,Norihiko Takegami ,Katsuto Tamai ,Hidetomi Terai ,Hitoshi Tonomura ,Hiroyuki Tsuchiya ,Toru Funayama ,Norihiro Suzuki ,Hitomi Suzuki ,Yasuchika Aoki ,Hideaki Nakajima ,Kota Watanabe ,Hideki Murakami ,Naoki Segi ,Hiroshi Uei ,Kenji Kato ,Yoshito Onoda ,Seiji Okada ,Hiroto Tokumoto ,Eiji Takasawa ,Katsuhito Kiyasu ,Ryosuke Hirota ,Bungo Otsuki ,Koji Akeda ,Kei Ando ,Yoshiaki Terashima ,Satoshi Nori ,Toshitaka Yoshii ,Hiroyuki Tominaga ,Hiroaki Nakashima ,Yuji Kakiuchi ,Takashi Kaito ,Noriaki Yokogawa ,Ken Ishii ,Shiro Imagama ,Katsumi Harimaya ,Atsushi Yunde ,Kenichiro Kakutani ,Satoshi Kato

doi:10.1186/s12891-022-05752-5

Abstract

BackgroundThe 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older.MethodsThree hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted.ResultsOne year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively.ConclusionsThe 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.

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