Traumatic spinal cord injuries in geriatric population: etiology, management, and complications

The relationship of traumatic spinal cord injury (SCI) and the geriatric population is not emphasized in current literature. Our objective was to evaluate mechanisms of injury, outcomes, and complications of geriatric patients with traumatic SCI.

Patients with traumatic spinal cord injuries admitted to the inpatient rehabilitation unit of a level I trauma center from 2003 to 2013 were reviewed. Inclusion criteria were ages ≥65 years old and availability of complete medical records. Patient demographics, mechanism of injury, diagnoses, American Spinal Injury Association (ASIA) grade, management (surgical, nonsurgical), complications, and mortality were evaluated.

Seven hundred and fifty-seven SCI patients were identified and 53 met our inclusion criteria, with 35 (66.0%) males and 18 (34.0%) females. The average age was 74-years (range, 65 to 91 years). A proportion of 24.5% were 65-69 years of age, 30.2% were 70-74, 22.6% were 75-79, and 22.6% were 80 or older. Thirty-four (64.2%) underwent surgery. The two most common diagnoses of SCI were fractures (43.4%) and central cord syndrome (28.3%). ASIA grading was: A 5 (9.4%); B 3 (5.7%); C 5 (9.4%); D 40 (75.5%). The most severe SCI (ASIA score A and B) primarily occurred in the younger geriatric populations (ages 65-74), as did the highest rates of major complications or major and minor complications (15.4% and 46.2%, respectively, in the 65-69 group). Surgical management increased with age from 46.2% in the 65-69 group to 83.3% in the 75-79 group but subsequently decreased in the ≥80 group (66.7%).

Fractures and central cord syndrome were the most common diagnoses and typically due to falls. The complication rate in this population is high and due to complex causes. SCI in patients aged 65-69 was associated with increased rate of ASIA score A and increased rate of major complications.