Long-term outcomes after surgery for subaxial cervical spine injuries in octogenarians, a matched controlled analysis

Introduction: Due to an aging population and advances in surgery and anesthesia, spinal fusion surgeries are rising worldwide. Medical professions must adapt to geriatric care as life expectancy rises. Despite routine surgery for elderly subaxial cervical fractures, results are scarce. Finding risk markers that predict outcomes can improve senior surgical decision-making and safety.
Octogenarians and a matched group of younger subaxial cervical spine injury patients were compared for surgical outcomes and prognostic.

Methods: Eligible for inclusion were all patients surgically treated between 2006 and 2018, with either anterior or posterior fixation for subaxial cervical spine injuries at the study center. A cohort of octogenarians was identified and matched 1:1 to a corresponding cohort of younger adults based on the American Spinal Cord Injury Association (ASIA) Impairment Scale (AIS) at admission, surgical approach and number of fused levels. The primary outcomes were postoperative complications and mortality. Secondary outcomes were estimated blood loss and operative times.

Results: Both octogenarian and younger groups had 54 patients (median age: 84.0 vs. 38.5). Both groups underwent surgery within 2 days of cervical damage on average. No significant changes were seen in estimated blood loss (p=0.403) or operational time (p=0.625). Although surgical problems including dural rips and wound infections were similar between groups, postoperative medical complications such respiratory or urinary tract infections were significantly higher among the elderly (p < 0.001). The elderly had higher screw loosening (p=0.027), but revision procedures were similar (p=0.495). Short- and long-term neurological results (AIS) were similar between groups (p=0.860 and p=0.775). Elderly patients had higher 30- and 90-day death rates (19% vs. 2%; p=0.004 and 28% vs. 2%; p< 0.001). Propensity score matching eliminated these variations in American Society of Anesthesiology (ASA) grade attributable to elderly comorbidities.

Conclusion : Octogenarians with comorbidities had higher short-term mortality due to surgical complications such infections. However, octogenarians without comorbidities fared similarly to younger patients. These data suggest that octogenarian surgical decision-making should reflect overall health, including comorbidities, rather than chronological age.