The Impact of Cervical Spine Fractures on Mortality Across Age Groups: A National Trauma Data Bank Study

Introduction: Traumatic cervical spinal cord injury (TSCI) imparts significant morbidity and mortality. The presence of cervical spine fractures (CSFx) in conjunction with TSCI has been shown to significantly increase mortality, particularly in the elderly. However, the impact of CSFx on mortality across age ranges has not been described.

Methods: The National Trauma Bank for the years 2019-2021 was assessed for patients with cervical spinal cord injury (CSCI). Patients with CSCI were organized into those with and without cervical spine fractures by use of the International Classification of Diseases (ICD)-10 and ICD-9 codes. Further categorization based on surgical intervention was determined by Current Procedural Terminology (CPT) codes.

Results: A total of 14,008 patients with TSCI were identified. Of these, there were 5,123 with and 8,885 without CSFx, respectively. In the 18-31 age range, mortality was 5.9% for fracture patients versus 3.1% for non-fracture patients (OR 2.00, 95% CI: 1.19-3.37, p < 0.01). In the 31-50 group, mortality was 5.3% with fractures and 1.7% without (OR 3.31, 95% CI: 2.14-5.13, p < 0.005), with a greater mortality reduction in the non-fracture group. Mortality rose to 8.4% and .3% in the fracture and non-fracture groups, respectively in the 51-70 range (OR 2.66, 95% CI: 2.10-3.38, p < 0.005). The highest mortality occurred in the ≥71 age group with a frequency of 22.2% and 10.7% in the fracture and non-fracture groups, respectively (OR 2.38, 95% CI: 1.98-2.85, p < 0.005).

Conclusion : Age and fracture status are predictive of mortality in TSCI patients. The presence of a cervical spine fracture nearly doubles the risk of mortality across all age groups. Although the highest risk of mortality was found in the ≥71 age group, the highest relative risk of mortality was observed in the 31-50 age group. Further research is warranted to delineate the relative increase in mortality for patients with TSCI and CSFx in the 31-50 age cohort.