Older adults with cervical spine fractures – Epidemiology, management and outcomes from a level 1 trauma centre

Introduction: Cervical spine fractures are common in older adults, although reports of the epidemiology and outcomes of this patient cohort are scant. The aim of this study was to review the epidemiology, management and outcomes (hospital-based and patient-reported) of older patients with cervical fractures admitted to a level 1 trauma centre. Methods: Patients aged ≥65 years who were admitted to The Alfred and included on the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) with a cervical spine fracture were included. Demographics and management (surgery, halo thoracic orthosis or conservative), as well as hospital and 6-month outcomes were analysed. Factors associated with cervical spine management and outcomes (discharge destination and being at home at 6 months post-injury) were assessed using logistic regression. Results: Between 2016 and 2021, a total of 853 patients were included. Median age was 79 (IQR 72–86) years, with most (57.7%) being male. Low falls (59%) were common. Most patients were managed non-operatively [765 (89%)]. The median acute hospital length of stay was 6.8 (IQR 3.8–11.6) days and 90.6% of patients survived to hospital discharge. After adjusting for confounding factors, increasing age, female gender and having an intensive care unit stay were associated with discharge to another inpatient facility as well as not returning to live at home at 6 months. There was no association between the cervical spine management and 6-month quality of life outcomes. Conclusion: Overall mortality rate was low with most patients returning to independent living at home 6 months post-injury. Considering those factors associated with poorer outcomes may provide useful information to determine optimal pathways for this cohort.