Management of Cervical Trauma in Elderly Patients: A Propensity Score-Matched Comparison of Anterior vs. Posterior Approaches

Introduction: Cervical spine injuries often lead to long-term disability, causing significant motor and sensory deficits and chronic pain. Prompt surgical intervention is vital to prevent further neurological deterioration and instability, especially in elderly patients who tend to have higher complication rates due to comorbidities and extended recovery periods. This study aims to investigate in-hospital complications following anterior and posterior spinal fusion surgeries in elderly patients, providing valuable insights for clinical decision-making in an understudied population.

Methods: The National Trauma Data Bank was queried from 2017 to 2019 for all patients above the age of 65 with cervical trauma who underwent subsequent spinal fusion surgery with anterior or posterior approaches. Patients receiving combined management were excluded. Statistical analyses, including Student's t-tests and Chi-squared tests, were conducted to compare patient demographics, in-hospital complications, and lengths of stay between the two surgical groups. Alpha was set to 0.05.

Results: A total of 10,593 patients meeting the inclusion criteria were identified, with 1,675 patients undergoing fusion with an anterior approach and 1,317 patients with a posterior approach. In both groups, the majority of patients had sustained minor injuries according to the AIS severity scale. Patients in the posterior approach group displayed a higher proportion of white, female patients, and those with private insurance. They also had a higher total Glasgow Coma Scale (GCS) score (p < 0.05 for all). After matching, they had a significantly lower risk of developing DVTs, experiencing cardiac arrest, and requiring intubation (p < 0.05 for all).

Conclusion : To our knowledge, this study represents the largest investigation into disparities in in-hospital complications between surgical approaches for cervical trauma in elderly patients. Our findings suggest that the posterior approach may offer a lower risk of short-term complications, underscoring its clinical advantages. Further research is warranted to uncover the long-term implications of these surgical choices.