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World Neurosurg. 2018 Feb;110:e427-e437. doi: 10.1016/j.wneu.2017.11.011. Epub 2017 Nov 11.

Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013.

Author information

1
Division of Spinal Surgery, Department of Orthopaedic Surgery and Neurological Surgery, New York University Langone Medical Center, Orthopaedic Hospital, New York University School of Medicine, New York Spine Institute, New York, New York, USA. Electronic address: pgpassias@yahoo.com.
2
Division of Spinal Surgery, Department of Orthopaedic Surgery and Neurological Surgery, New York University Langone Medical Center, Orthopaedic Hospital, New York University School of Medicine, New York Spine Institute, New York, New York, USA.
3
Department of Orthopaedic Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, USA.
4
Bronx-Lebanon Hospital, Bronx, New York, USA.
5
Eastern Virginia Medical School, Norfolk, East Virginia, USA.
6
Spine Center Bad Wildungen, Werner-Wicker-Klinik, Im Kreuzfeld, Bad Wildugnen, Germany.
7
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.

Abstract

OBJECTIVE:

The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures.

METHODS:

A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ2 for categorical variables. Level of significance was P < 0.05.

RESULTS:

A total of 488,262 patients were isolated (age, 55.96 years; male, 60.0%; white, 77.5%). Incidence (2005, 4.1% vs. 2013, 5.4%), Charlson Comorbidity Index (2005, 0.6150 vs. 2013, 1.1178), and total charges (2005, $71,228.60 vs. 2013, $108,119.29) have increased since 2005, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The most frequent fracture types were closed at C2 (32.0%) and C7 (20.9%). Concurrent injury rates have significantly increased since 2005 (2005, 62.3% vs. 2013, 67.6%). Common concurrent injuries included fractures to the rib/sternum/larynx/trachea (19.6%). Overall fusion rates have increased since 2005 (2005, 15.7% vs. 2013, 18.0%), whereas decompressions and halo insertion rates have decreased (all P < 0.05). SCIs have significantly decreased since 2005, except for upper cervical central cord syndrome. Complication rates have significantly increased since 2005 (2005, 31.6% vs. 2013, 36.2%). Common complications included anemia (7.7%), mortality (6.6%), and acute respiratory distress syndrome (6.6%).

CONCLUSIONS:

Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.

KEYWORDS:

Cervical spine; Cervical spine fracture; Epidemiology; Etiology; Fracture; Trauma

PMID:
29138069
DOI:
10.1016/j.wneu.2017.11.011
[Indexed for MEDLINE]

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