Cervical vertebral injuries in the elderly: A 10-year study

Abstract

The purpose of this investigation was to study the incidence patterns of cervical vertebral injuries in the elderly (ages 65 years and over) and to identify differences in these incidences when compared with a younger patient population (ages 15–64 years).

A retrospective review of all elderly patients identified as sustaining cervical injuries at a level I trauma center from 1986 to 1991 was performed as well as a prospective study of those encountered from 1991 through 1995. A comparison was made with a group of younger patients with similar injuries identified during the same time periods.

Nine hundred eighty patients sustained cervical fractures, dislocations, or cord injuries. Of these, 231 (24%) patients were over the age of 65 years and had a total of 274 injuries; 749 (76%) were between the ages of 15 and 64 years and had a total of 870 injuries. Of the elderly patients, there were 131 injuries at C2 (48%), including 17 delayed diagnoses. Forty-three patients had neurologic deficits (19%). By comparison, there were 241 C2 injuries (28%) in the younger patient group. The majority of injuries in this group were clustered at C5 and C6. One hundred seventy-one patients had neurologic deficits (23%). Spinal cord injury occurred in 21 patients over the age of 65 years (9%) and in 22 patients under the age of 65 years (3%).

The elderly are more likely to sustain injuries to the upper cervical region, particularly at C2. The incidence of spinal cord injury is three times higher in the elderly population. Radiologists and clinicians must be aware of the different incidence patterns of cervical vertebral injuries in the elderly and pay particular attention to the upper cervical region in this patient population.