Traumatic Cervical Spinal Injury Research Articles

Postoperative opioid consumption patterns diverge between propensity matched patients undergoing traumatic and elective cervical spine fusion

BACKGROUND CONTEXTProlonged opioid therapy following spine surgery is an ongoing postoperative concern. While prior studies have investigated postoperative opioid use patterns in the elective cervical surgery patient population, to our knowledge, opioid use patterns in patients undergoing surgery for traumatic cervical spine injuries have not been elucidated. PURPOSEThe purpose of this study was to compare opioid use and prescription patterns in the postoperative pain management of patients undergoing traumatic and elective cervical spine fusion surgery. STUDY DESIGNRetrospective cohort study. PATIENT SAMPLEAdult patients with traumatic cervical injuries who underwent primary anterior cervical discectomy and fusion (ACDF) or posterior cervical decompression and fusion (PCDF) during their initial hospital admission. The propensity matched, control group consisted of adult elective cervical fusion patients who underwent primary ACDF or PCDF. OUTCOME MEASURESDemographic data, surgical characteristics, spinal disease diagnosis, location of cervical injury, procedure type, operative levels fused, and Prescription Drug Monitoring Program (PDMP) data. PDMP data included the number of opioid prescriptions filled, preoperative opioid use, postoperative opioid use, and use of perioperative benzodiazepines, muscle relaxants, or gabapentin. Opioid consumption data was collected in morphine milligram equivalents (MME) and standardized per day. METHODSA 1:1 propensity match was performed to match traumatic injury patients undergoing cervical fusion surgery with elective cervical fusion patients. Traumatic injury patients were matched based on age, sex, CCI, procedure type, and cervical levels fused. Pre- and postoperative opioid, benzodiazepine, muscle relaxant, and gabapentin use were assessed for the traumatic injury and elective patients. T- or Mann-Whitney U tests were used to compare continuous data and Chi-Squared or Fisher's Exact were used to compare categorical data. Multivariate stepwise regression using MME per day 0 – 30 days following surgery as the dependent outcome was performed to further evaluate associations with postoperative opioid use. RESULTSA total of 48 patients underwent fusion surgery for a traumatic cervical spine injury and 48 elective cervical fusion with complete PDMP data were assessed. Elective patients were found to fill more prescriptions (3.19 vs 0.65, p=.023) and take more morphine milligram equivalents (MME) per day (0.60 vs 0.04, p=.014) within 1 year prior to surgery in comparison to traumatic patients. Elective patients were also more likely to use opioids (29.2% vs 10.4%, p=.040) and take more MMEs per day (0.70 vs 0.05, p=.004) within 30 days prior to surgery. Within 30 days postoperatively, elective patients used opioids more frequently (89.6% vs 52.1%, p<.001) and took more MMEs per day (3.73 vs 1.71, p<.001) than traumatic injury patients. Multivariate stepwise regression demonstrated preoperative opioid use (Estimate: 1.87, p=.013) to be correlated with higher postoperative MME per day within 30 days of surgery. Surgery after traumatic injury was correlated with lower postoperative MME use per day within 30 days of surgery (Estimate: −1.63 p=.022). CONCLUSIONCervical fusion patients with a history of traumatic spine injury consume fewer opioids in the early postoperative period in comparison to elective cervical fusion patients, however both cohorts consumed a similar amount after the initial 30-day postoperative period. Preoperative opioid use was also a risk factor for higher consumption in the short-term postoperative period. These results may aid physicians in further understanding patients’ postoperative care needs based on presenting injury characteristics and highlights the need for enhanced follow-up care for traumatic cervical spine injury patients after fusion surgery.

A system of predictive scores to evaluate the risk of multilevel noncontiguous spinal fractures in patients with traumatic cervical spine injury.

To develop a predictive scoring system to identify traumatic cervical spine injury patients at a high risk of having multilevel noncontiguous spinal fractures. This 12-year retrospective observational cohort study included 588 traumatic cervical spine-injured patients. Patients were categorized into two groups: patients with multilevel noncontiguous spinal fractures and patients without this remote injury. Potential risk factors were examined using multivariable analysis to derive a predictive risk score from independent predictors. Results are presented as odds ratio with a 95% confidence interval (95% CI). The accuracy of the calculated predicted score was demonstrated by the area under the receiver operating characteristic curve (AuROC). The incidence of noncontiguous fracture among the patients was 17% (100 of 588). The independent risk factors associated with multilevel noncontiguous spinal fractures were motor weakness, intracranial injury, intrathoracic injury, and intraabdominal injury. The AuROC of the prediction score was 0.74 (95% CI 0.69, 0.80). The patients were classified into three groups, low-risk group (score< 1), moderate-risk group (score 1-2.5), and high-risk group (score≥ 3), based on the predicted risk of multilevel noncontiguous spinal fractures. This tool can potentially help preventing the missed diagnosis of cervical spine injuries with multilevel noncontiguous spinal fractures. CT scans or MRI of the entire spine to investigate remote multilevel noncontiguous spinal fractures may have a role in cervical spine-injured patients who have at least one of the independent risk factors and are strongly suggested for patients with scores in the high-risk group.

Comparison of iCT-based navigation and fluoroscopic-guidance for atlantoaxial screw placement in 78 patients with traumatic cervical spine injuries

Background contextStudies have shown biomechanical superiority of cervical pedicle screw placement over other techniques. However, accurate placement is challenging due to the inherent risk of neurovascular complications. Navigation technology based on intraoperative 3D imaging allows highly accurate screw placement, yet studies specifically investigating screw placement in patients with traumatic atlantoaxial injuries are scarce. The aim of this study was to compare atlantoaxial screw placement as treatment of traumatic instabilities using iCT-based navigation or fluoroscopic-guidance with intraoperative 3D control scans.MethodsThis was a retrospective review of patients with traumatic atlantoaxial injuries treated operatively with dorsal stabilization of C1 and C2. Patients were either assigned to the intraoperative navigation or fluoroscopic-guidance group. Screw accuracy, procedure time, and revisions were compared.ResultsSeventy-eight patients were included in this study with 51 patients in the navigation group and 27 patients in the fluoroscopic-guidance group. In total, 312 screws were placed in C1 and C2. Screw accuracy was high in both groups; however, pedicle perforations > 1 mm occurred significantly more often in the fluoroscopic-guidance group (P = 0.02). Procedure time was on average 23 min shorter in the navigation group (P = 0.02).ConclusionsThis study contributes to the available data showing that navigated atlantoaxial screw placement proves to be feasible as well as highly accurate compared to the fluoroscopic-guidance technique without prolonging the time needed for surgery. When comparing these data with other studies, the application of different classification systems for assessment of screw accuracy should be considered.

Respiratory Morbidity and Mortality of Traumatic Cervical Spinal Injury.

Traumatic cervical spinal injuries can severely affect respiratory function and cause significant morbidity and mortality. The typical respiratory morbidity in cervical spine injury is Atelectasis, Ventilator-associated pneumonia, acute respiratory distress syndrome and delayed weaning, etc. The study aims to see the prevalence of respiratory morbidity as well as mortality associated with cervical spine injury. Cross sectional study based on retrospective data was conducted on the X Sciences with the existing hospital record during the period of 3 years to find out the prevalence respiratory morbidity like Ventilatory Associated Pneumonia, delayed weaning, ARDS, atelectasis of traumatic cervical spine injury, determine the prevalence, type, and impact of respiratory morbidity and mortality in this population. Total no 76 patients data meeting the inclusion criteria included in study. Male patients were more prone to develop traumatic cervical spinal injuries (SCI). The prevalence of respiratory morbidity in term of VAP(57.89), delayed weaning(46.05) and Atelectasis(22.36) was high. Patients with Asia A Neurology has higher association for VAP and delayed weaning, while Asia E Neurology patients had no respiratory morbidity. The study found a significant positive association between respiratory morbidity with hospital stay, and ventilator days (p-value: 0.019 and 0.048). A total of 15 patients died, 28.95% were discharged on request and 40.8% leaving the hospital against medical advice. The prevalence of respiratory morbidity higher in cervical spine injury. Furthermore, it has associated with prolonged ICU and ventilator days and increase in mortality.

Overview of Ventilator-Associated Pneumonia in Traumatic Cervical Spinal Injury in Trauma Center of Nepal

Background Cervical spine, crucial for nerve innervation and head and neck motion, is vulnerable to injury due to its over-reliance on ligaments. This study examines the increasing incidence of traumatic spinal cord injuries, particularly in fall and traffic accidents, with respiratory complications being the leading cause of morbidity and mortality, with VAP being a significant complication. MethodsA retrospective cross-section study involving 52 patient data, using self-prepared proforma. The patient’s age, sex, injury severity, and CPIS score were used to determine VAP.ResultsThe study involved 52 patients with a mean age of 50.96. Of these, 67.3% were male and 11.5% female, with 45-60 years being the most common age group. The most severe spinal injury patients, i.e., ASIA A Neurology, developed VAP. Patients with prolonged ICU stay and intubation days also developed VAP, but no statistical significance was seen (P-value: 0.3941 and 0.4751). Mortality had a significant association with VAP (P-value: 0.023). Acinetobacter Baumann was the most common microorganism causing VAP, while Staphylococcus aureus was the least common. The most sensitive antibiotics for isolated organisms were Polymyxin B, Amikacin, Colistin, and Levofloxacin.Conclusions The study found a high prevalence of ventilator association pneumonia (VAP) in cervical spine fracture patients, with mortality associated with the most common organism being Acinetobacter, sensitivity to Polymyxin b. Further monitoring and implementation of VAP prevention strategies are recommended.

Development of a Novel Risk Stratification Score to Predict 30-Day Mortality in Cervical Trauma Patients: CLAAD Score.

Case control. Traumatic cervical spine injuries are associated with a substantial risk of mortality. The aim of this study is to develop a novel mortality prediction model for patients with cervical trauma who require operative treatment. Patients with cervical spine trauma have a high risk of postoperative complications and mortality. There are few reliable systems that can accurately predict mortality after surgery for cervical spine trauma, and those that do exist are typically not specific to cervical trauma. The National Surgical Quality Improvement Program (NSQIP) database was used to identify patients undergoing surgery for cervical spine trauma. Univariate analyses were performed to identify variables associated with mortality. Variables that were found to be significant in the univariate models were compiled into a multivariable model. The final model was compared with the American Society of Anesthesiologists (ASA), a modified Charlson comorbidity index (mCCI), and the 5-factor modified frailty index (mFI-5) in respect to predicting 30-day mortality after cervical trauma. The score was then externally validated using the Nationwide Inpatient Sample (NIS) database. Fifty-five (6.7%) of 822 patients did not survive 30 days after surgery. The final multivariable logistic regression model consisted of the following variables: circumferential fusion "C." long "L" fusion (more than 4 levels), anemia "A," age over 60 "A," and dialysis "D." The risk of mortality increased with increasing CLAAD score, with mortality rates of 0.9%, 3.1%, 7.4%, 22.7%, and 14.3% for scores of 0, 1, 2, 3, and 4, respectively. The CLAAD model had an AUC of 0.73 for predicting mortality after cervical trauma. The CLAAD score is a simple and effective system that can help identify patients at risk of increased mortality within 30 days of cervical trauma. Level III.

Comparison of head positioning using the Mayfield skull clamp versus padded headrest in anterior cervical discectomy and fusion surgery.

Anterior cervical discectomy and fusion (ACDF) is a commonly implemented surgical intervention for a variety of pathologies affecting the cervical spine. The current literature and daily practice reveal variations on patient head positioning for this procedure with both rigid fixations in the Mayfield skull clamp as well as use of a padded headrest being used. In this study, we therefore examine whether patients undergoing surgery using head positioning in the Mayfield skull clamp versus a padded headrest differ in regard to adverse events, surgical parameters and clinical outcome. A single-center, retrospective analysis of 121 patients treated with ACDF for degenerative disease, traumatic cervical spine injury and infectious disease between November 2019 and March 2023 was performed. Clinical and imaging data for 59 patients positioned in the Mayfield skull clamp and 62 patients positioned in a padded headrest were evaluated using electronic medical records. In addition to demographic data, surgical indications, procedures performed were analyzed for both groups. Level of training (chief, attending and resident), length of surgery and intraoperative radiation exposure (measured by dose area product and total radiation time) were also examined. Finally, modified Rankin Scale (mRS) preoperatively and at last follow-up as well as adverse events were compared between groups. We found no statistically significant differences between the Mayfield and headrest groups regarding surgical indications (P=0.583), procedures performed (P=0.069), level of training of the surgeon (P=0.218), length of surgery (P=0.752), adverse events (P=0.619) or neurological impairment (P=0.080) following surgical intervention. There was a significant difference regarding dose area product between both groups with patients positioned in the Mayfield skull clamp showing lower mean levels of radiation than those in the headrest group (99 versus 131 cGy/cm2; P=0.003). Patient positioning using the Mayfield skull clamp may reduce required radiation exposure during ACDF procedures versus use of a padded headrest.

Surgical Outcomes in Octogenarians with Central Cord Syndrome: A Propensity-Score Matched Analysis

IntroductionCentral cord syndrome (CCS) is a traumatic cervical spine injury that is treated with surgical decompression. In octogenarians (80-89), surgeons often opt for conservative management instead due to fears of postoperative complications and prolonged recovery times. This study aims to assess the in-hospital complications and outcomes in octogenarians undergoing surgery compared to those undergoing non-surgical management for CCS. MethodsThe National Trauma Data Bank was queried from 2017 to 2019 for octogenarians with CCS. Patients who received surgical fusion or decompression were divided into the surgery group and the remaining into the non-surgical group. The surgery group was sampled and propensity score matched with the non-surgery group. Student’s t-tests and Pearson’s chi-squared tests were used to test for group differences. ResultsA total of 759 octogenarians with CCS were identified. Following sampling and propensity score matching, 225 patients were identified in each group. The surgery group experienced longer ICU (6.8 days vs. 3.21 days, p < 0.001) and hospital (13.79 days vs. 7.8 days, p < 0.001) lengths of stay (LOS) and higher rates of deep vein thrombosis (4.89% vs. 0.44%, p = 0.02) and ventilator-associated pneumonia (4% vs. 0%, p = 0.02). Patients did not otherwise differ in mortality rate, other hospital complications, and discharge disposition. ConclusionOctogenarians undergoing surgery for CCS experience longer LOS and complications consistent with prolonged hospitalization, but otherwise have similar mortality, hospital complications, and discharge disposition compared to non-surgical treatment. Given the relative lack of short-term drawbacks, surgery should be considered first-line management when the long-term benefits are substantive.

Early Versus Delayed Surgery for Elderly Traumatic Cervical Spinal Injury: A Nationwide Multicenter Study in Japan.

Retrospective multicenter study. The effectiveness of early surgery for cervical spinal injury (CSI) has been demonstrated. However, whether early surgery improves outcomes in the elderly remains unclear. This study investigated whether early surgery for CSI in elderly affects complication rates and neurological outcomes. This retrospective multicenter study included 462 patients. We included patients with traumatic acute cervical spinal cord injury aged ≥65years who were treated surgically, whereas patients with American Spinal Injury Association (ASIA) Impairment Scale E, those with unknown operative procedures, and those waiting for surgery for >1month were excluded. The minimum follow-up period was 6months. Sixty-five patients (early group, 14.1%) underwent surgical treatment within 24hours, whereas the remaining 397 patients (85.9%) underwent surgery on a standby basis (delayed group). The propensity score-matched cohorts of 63 cases were compared. Patients in the early group were significantly younger, had significantly more subaxial dislocations (and fractures), tetraplegia, significantly lower ASIA motor scores, and ambulatory abilities 6months after injury. However, no significant differences in the rate of complications, ambulatory abilities, or ASIA Impairment Scale scores 6months after injury were observed between the matched cohorts. At 6months after injury, 61% of the patients in the early group (25% unsupported and 36% supported) and 53% of the patients in the delayed group (34% unsupported and 19% supported) were ambulatory. Early surgery is possible for CSI in elderly patients as the matched cohort reveals no significant difference in complication rates and neurological or ambulatory recovery between the early and delayed surgery groups.

Factors associated with non-contiguous spine fracture in patients with traumatic cervical spine injury: A 12-year retrospective study

Factors associated with non-contiguous spine fracture in patients with traumatic cervical spine injury: A 12-year retrospective study

The Epidemiological Characteristics and Type of Treatment in Iranian Patients with Traumatic Cervical Spine Injuries: a cohort study

The Epidemiological Characteristics and Type of Treatment in Iranian Patients with Traumatic Cervical Spine Injuries: a cohort study

Comparative Analysis of Interbody Cages versus Tricortical Graft in Isolated Traumatic Cervical Spine Injury Patients

Comparative Analysis of Interbody Cages versus Tricortical Graft in Isolated Traumatic Cervical Spine Injury Patients

Traumatic Cervical spine injury epidemiology: a tertiary care center perspective in Nepal

Background: The epidemiology of traumatic cervical spine injury is not well documented in developing/ underdeveloped countries. There are a few single-centered studies on the epidemiology of cervical spine injury in Nepal. Objectives: This study aimed to explore the epidemiology of traumatic cervical spine injuries presented at Dhulikhel Hospital, Kathmandu University Hospital, Nepal. Methods: This was a retrospective study of individuals with traumatic cervical spine injuries admitted to the Department of Orthopedics from 2015 January to 2021 December. Data collection was done by using the International Spinal Cord Injury core data set (version 2) and International Spinal Cord Injury Spinal Column Injury Basic Data Set (version 1.0). Results: One hundred and forty-four patients were included of which the majority (68.8%) were males. The mean age of the patients was 47.89 ± 17 years. Fall injury was the most common etiology (79.2%). C2 was the most common level injured (28.5%). Patients with ASIA A neurology was 18% and surgical treatment was given to nearly 60%. The patients had a median hospital stay of 9 days (4- 16) and a mortality of 4.2%. Conclusion: There was a male predominance with a recent increase in the female proportion for traumatic cervical spine injury. Fall was the most common etiology with the majority of patients in their 30s and 40s. Surgical treatment is more preferred recently. The mortality rate was relatively low which needs further investigation.

Transarticular Fixation Using Bioabsorptive Screws for Cervical Lesions.

Transarticular screw fixation is a method for posterior cervical fixation. It is ergonomic because neither connectors nor rods are needed. Biomechanical studies have shown that its fixation force is not inferior to that of lateral mass screws. More information is needed on the surgical outcome of procedures using bioabsorptive screws. We investigated the long-term surgical and radiological outcomes of posterior cervical decompression and fusion using bioabsorptive screws for transarticular fixation.Of 10 patients who underwent cervical spine transarticular fixation using bioabsorptive screws, nine presented with cervical degenerative spondylosis and one with a traumatic cervical spine injury. The mean postoperative follow-up period was 57.1 months. Transarticular screw fixation was successful in all 10 patients; no intraoperative complications were encountered. Bilateral screw breakage was discovered in a patient with cervical spine instability and associated dystonia due to cerebral palsy; there was no symptom deterioration, facet joint breakage, or instability exacerbation. Facet fusion was obtained in the nine other patients. At the patients' last visit, their clinical symptoms were significantly improved. Whole cervical spine alignment (-4.21 ± 7.2 to -5.2 ± 8.7) and the fused segment angle (mean, -0.1 ± 9.9 to -1.2 ± 13.7) did not significantly worsen postoperatively (mean: -0.1 ± 9.9 to -1.2 ± 13.7). Transarticular fixation using bioabsorptive screws is safe and associated with good long-term outcomes. In patients with exacerbation of local instability after posterior decompression, additional transarticular fixation using bioabsorbable screws is a treatment option.

Evolution of patient-reported outcome measures, 1, 2, and 5 years after surgery for subaxial cervical spine fractures, a nation-wide registry study

BACKGROUND CONTEXTA longer duration of patient follow up arguably provides more reliable data on the long-term effects of a treatment. However, the collection of long-term follow up data is resource demanding and often complicated by missing data and patients being lost to follow up. In surgical fixation for cervical spine fractures, data are lacking on the evolution of patient reported outcome measures (PROMs) beyond 1-year of follow up. We hypothesized that the PROMs would remain stable beyond the 1-year postoperative follow up mark, regardless of the surgical approach. PURPOSETo assess the trends in the evolution of patient-reported outcome measures (PROMs) at 1, 2-, and 5-years following surgery in patients with traumatic cervical spine injuries. STUDY DESIGNNation-wide observational study on prospectively collected data. PATIENT SAMPLEIndividuals treated for subaxial cervical spine fractures with anterior, posterior, or combined anteroposterior approaches, between 2006 and 2016 were identified in the Swedish Spine Registry (Swespine). OUTCOME MEASURESPROMs consisting of EQ-5D-3Lindex and the Neck Disability Index (NDI) were considered. METHODSPROMs data were available for 292 patients at 1 and 2 years postoperatively. Five-years PROMs data were available for 142 of these patients. A simultaneous within-group (longitudinal) and between group (approach-dependent) analysis was performed using mixed ANOVA. The predictive ability of 1-year PROMs was subsequently assessed using linear regression. RESULTSMixed ANOVA revealed that PROMs remained stable from 1- to 2-years as well as from 2- to 5-years postoperatively and were not significantly affected by the surgical approach (p<0.05). A strong correlation was found between 1-year and both 2- and 5-years PROMs (R>0.7; p<0.001). Linear regression confirmed the accuracy of 1-year PROMs in predicting both 2- and 5-years PROMs (p<0.001). CONCLUSIONPROMs remained stable beyond 1-year of follow up in patients treated with anterior, posterior, or combined anteroposterior surgeries for subaxial cervical spine fractures. The 1-year PROMs were strong predictors of PROMs measured at 2, and 5 years. The 1-year PROMs were sufficient to assess the outcomes of subaxial cervical fixation irrespective of the surgical approach.

Purple urine bag syndrome: An unusual presentation of urinary tract infection

Introduction: Purple urine bag syndrome is a rare clinical entity characterized by purple discoloration of the urinary catheter and urinary drainage bag in chronically catheterized patients. Though it can be alarming to patients and clinicians, it is considered benign but can indicate an underlying urinary tract infection. Case Series: The first case was a 68-year-old woman with multiple comorbidities who was admitted to the orthopedic ward with a close fracture of the neck of the right femur. She was bedridden and had an indwelling urethral catheter. Her urine bag was noticed to stain purplish 22 days after bladder catheterization. Urine culture showed a heavy mixed growth. A change of urinary catheter and drainage bag led to a resolution of the condition. The second case was a 58-year-old male who was admitted on account of decompensated liver cirrhosis from chronic hepatitis C virus infection. He also had quadriparesis due to a traumatic cervical spine injury, urine retention, and constipation. On day 24 of his admission, his urine bag was stained with a purplish hue. A urine culture grew Klebsiella oxytoca. The urine bag remained clear and contained amber-colored urine after catheter changes and antibiotic treatment for cystitis. Conclusion: Purple urine bag syndrome can be alarming to the patient and caregiver who need to be reassured of its benign nature. Urine culture would identify any associated infection. Good catheter care, control of risk factors including constipation and antibiotic treatment for symptomatic urinary tract infection leads to the resolution of the discoloration.

Airway Management In Patients With Traumatic Cervical Spine Injury For Emergency Surgery: A Case Series

Airway Management In Patients With Traumatic Cervical Spine Injury For Emergency Surgery: A Case Series

Effects of Dementia on Outcomes after Cervical Spine Injuries in Elderly Patients: Evaluation of 1512 Cases in a Nationwide Multicenter Study in Japan.

We aimed to retrospectively investigate the demographic characteristics and short-term outcomes of traumatic cervical spine injuries in patients with dementia. We enrolled 1512 patients aged ≥ 65 years with traumatic cervical injuries registered in a multicenter study database. Patients were divided into two groups according to the presence of dementia, and 95 patients (6.3%) had dementia. Univariate analysis revealed that the dementia group comprised patients who were older and predominantly female and had lower body mass index, higher modified 5-item frailty index (mFI-5), lower pre-injury activities of daily living (ADLs), and a larger number of comorbidities than patients without dementia. Furthermore, 61 patient pairs were selected through propensity score matching with adjustments for age, sex, pre-injury ADLs, American Spinal Injury Association Impairment Scale score at the time of injury, and the administration of surgical treatment. In the univariate analysis of the matched groups, patients with dementia had significantly lower ADLs at 6 months and a higher incidence of dysphagia up to 6 months than patients without dementia. Kaplan-Meier analysis revealed that patients with dementia had a higher mortality than those without dementia until the last follow-up. Dementia was associated with poor ADLs and higher mortality rates after traumatic cervical spine injuries in elderly patients.

Risk Factors for Early Mortality in Older Patients with Traumatic Cervical Spine Injuries-A Multicenter Retrospective Study of 1512 Cases.

For older patients with decreased reserve function, traumatic cervical spine injuries frequently lead to early mortality. However, the prognostic factors for early mortality remain unclear. This study included patients aged ≥65 years and hospitalized for treatment of traumatic cervical spine injuries in 78 hospitals between 2010 and 2020. Early mortality was defined as death within 90 days after injury. We evaluated the relationship between early mortality and the following factors: age, sex, body mass index, history of drinking and smoking, injury mechanisms, presence of a cervical spine fracture and dislocation, cervical ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, American Spinal Injury Association Impairment Scale, concomitant injury, pre-existing comorbidities, steroid administration, and treatment plan. Overall, 1512 patients (mean age, 75.8 ± 6.9 years) were included in the study. The early mortality rate was 4.0%. Multivariate analysis identified older age (OR = 1.1, p < 0.001), male sex (OR = 3.7, p = 0.009), cervical spine fracture (OR = 4.2, p < 0.001), complete motor paralysis (OR = 8.4, p < 0.001), and chronic kidney disease (OR = 5.3, p < 0.001) as risk factors for early mortality. Older age, male sex, cervical spine fracture, complete motor paralysis, and chronic kidney disease are prognostic factors for early mortality in older patients with traumatic cervical spine injuries.

Socio-demographic factors, clinico-radiological profile of patients with traumatic cervical spine injury in South India, and its association with short-term clinical outcome.

Spinal cord injury is a devastating condition to an individual and his/her family imposing an economic burden on the family, society, and the country. Finding out the demographic and morbidity profile of cervical spine injuries is essential for formulating means and ways for its prevention and treatment. This study aimed at assessing the clinico-radiological and socio-demographic profile of cervical spine injury patients and their association with short-term clinical outcomes. This was a prospective observational study that included 120 patients with cervical spine/cord injury. Social, demographic, clinical, and radiological parameters of the study participants were recorded. Improvement, worsening, and neurological stability at 2 weeks follow-ups were considered as a short-term outcome. The association of neurological outcomes with clinico-radiological profile and socio-demographic characteristics was analyzed to study the level of significance. The study found that nearly 81% of the study participants were involved in heavy physical activity, and 45% of the cases sustained cervical spine injury because of falls from height. About 37% and 55% of patients had complete and incomplete cord injury, respectively. Computerized tomography of the spine injury patients showed a fracture, subluxation, and locked facets. Magnetic resonance imaging showed disco-ligamentous injury and cord contusion in these patients. Nearly 29% of patients showed motor improvement, and around 4% of patients had a worsening of their neurological status after 2 weeks. Most of the people who sustain cervical spine injuries are involved in heavy physical work. Female gender, incomplete cord injury, and unilateral locked facet in subluxation are associated with good neurological outcomes. This study will form a preliminary base to build a larger database on spinal cord injury at the regional and national levels.