Multiple-level noncontiguous spinal fractures: difference between the young and the elderly

We retrospectively reviewed the hospital records of all patients with multiple-level noncontiguous spinal fractures (MLNSF) at university-affiliated hospitals between January 2001 and May 2011 (n=213). The variables assessed included age, sex, spinal fracture mechanism, anatomic distribution, neurological deficit, and associated injury.

The purpose of our study was to better understand the patterns of MLNSF, with an emphasis on comparing young and elderly patients.

There are many studies on the characteristics of noncontiguous spinal fractures, but these existing studies do not differentiate between young and elderly patients with noncontiguous spinal fractures.

A total of 213 patients with MLNSF were enrolled, of whom 57.3% (122/213) were male and 67.1% (143/213) were young patients (age less than 60 y). Accidental falls from a high height and road traffic crashes were the most common injuries leading to spinal fractures (44.1% and 22.4%, respectively) among young patients, whereas osteoporotic spinal fractures and accidental falls from a low height (38.6% and 28.6%, respectively) were the most common causes of spinal injuries among elderly patients. The most common region suffering MLNSF among young patients was the thoracic+lumbar region (36.4%), followed by the cervical+thoracic region (23.8%). Among elderly patients, the thoracic+lumbar region (52.9%) followed by the thoracic+thoracic region (35.7%) were the most common regions suffering MLNSF. The frequency of neurological deficit was significantly different between the young and the elderly patients (57.3% and 21.4%, respectively). A total of 73 (51.0%, 73/143) young patients had associated nonspinal injuries, and 9 (12.9%, 9/70) elderly patients had such injuries.

Of all the patients with MLNSF, the risk of noncontiguous spinal fractures with neurological deficit and associated injuries in the elderly patients was lower than that among young patients. The thoracic+lumbar region was the most common region of injury among all patients, and the cervical+thoracic region was more commonly injured among young patients. Clinicians should make their diagnoses and direct their injury prevention strategies according to the characteristics of MLNSF in a specific age group.