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Uptrend of cervical and sacral fractures underlie increase in spinal fractures in the elderly, 2003–2017: analysis of a state-wide population database

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Abstract

Background

Traumatic spinal injuries can be life-threatening conditions. Despite numerous epidemiological studies, reports on specific spinal regions affected are lacking.

Hypothesis

We hypothesized that fractures at specific regions, such as the cervical spine (including the axis segment), have been affected to a greater degree. We also hypothesized that advanced age may be a significant contributing factor.

Objective

To longitudinally analyze trend of spine fractures and specific fracture subtypes.

Study design

Longitudinal trend analysis of discharged patient state database.

Patient sample

Discharged patient’s data from 15 years (2003–2017)

Methods

We retrieved pertinent ICD-9 and 10 codes depicting fractures involving the entire spine and specific subtypes. To assess possible association with age, we analyzed the trend of the average age in patients discharged with and without spinal fractures as well as in specific fracture subtypes. Similar analysis was performed for other common fragility fractures. FDA device/drug status: The manuscript submitted does not contain information about medical device(s) or drug(s).

Results

We found that within 15 years, the overall proportion of spinal fractures has increased by 64% (from 0.47 to 0.77% of all discharged patients) with the greatest increase noted in fractures of the cervical spine (123%) and specifically of the second cervical vertebra (84%). Age was found to have increased more in patients with spinal fractures than in the general discharged population. Surprisingly, other non-spinal fractures among patients above 60 remained relatively stable, demonstrating a spine-specific effect.

Conclusions

Our findings confirm a recent increase in all spinal fractures and in the cervical and sacral regions in particular. Advanced age may be an important underlying factor.

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Authors and Affiliations

  1. Swedish Neuroscience Institute, Seattle, WA, USA

    Ronen Blecher, Rod J. Oskouian & Jens R. Chapman

  2. Assuta University Hospital Ashdod, Ben Gurion University of the Negev, Ashdod, Israel

    Ronen Blecher, Motti Kramer & Michael Drexler

  3. Seattle Science Foundation, Seattle, WA, USA

    Emre Yilmaz & Basem Ishak

  4. BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany

    Emre Yilmaz & Alexander von Glinski

  5. Department of Neurosurgery, Wayne State University, Detroit, MI, USA

    Marc Moisi

  6. Department of Evidence Based Medicine, Spectrum Research Inc., Tacoma, WA, USA

    Joseph Dettori

Authors
  1. Ronen Blecher
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  2. Emre Yilmaz
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  3. Basem Ishak
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  4. Alexander von Glinski
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  5. Marc Moisi
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  6. Rod J. Oskouian
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  7. Joseph Dettori
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  8. Motti Kramer
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  9. Michael Drexler
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  10. Jens R. Chapman
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Corresponding author

Correspondence to Jens R. Chapman.

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Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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The authors hereby certify that the current research was conducted in its entirety in the Swedish Neuroscience Institute, Seattle, WA.

Appendix

Appendix

  1. (1)

    List of codes used for the identification of spinal fractures

ICD 9

Cervical: 8050*; 8051*; 8060*; 8061* (axis fractures: 80502; 80512)

Thoracic: 8052; 8053; 8062*; 8063*

Lumbar: 8054; 8055; 8064*; 8065*

Sacro-coccygeal: 8056; 8057; 8066*; 8067*

Distal radius: 81341*; 81342*; 81344*; 81351*; 81352*; 81354*

Proximal femur: 820*

ICD 10

Cervical: S120*; S121*; S122*; S123*; S124*; S125*; S126*; S129*

Thoracic: S2200*; S2201*; S2202*; S2203*; S2204*; S2205*; S2206*; S2207*; S2208*

Lumbar: S320*

Sacro-coccygeal: S321*

Distal radius: S525*

Proximal femur: S720*; S721*; S722*

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Blecher, R., Yilmaz, E., Ishak, B. et al. Uptrend of cervical and sacral fractures underlie increase in spinal fractures in the elderly, 2003–2017: analysis of a state-wide population database. Eur Spine J 29, 2543–2549 (2020). https://doi.org/10.1007/s00586-020-06498-1

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  • DOI: https://doi.org/10.1007/s00586-020-06498-1

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