Characteristics of noncontinuous multilevel spinal fractures: an age-group specific analysis

Noncontinuous multilevel fractures (NMF) are complex injuries characterized by spinal fractures at non-adjacent levels, with reported incidence ranging from 1.6 to 17.7% depending on imaging modalities. Typically resulting from high-energy trauma such as motor vehicle accidents, NMF can also occur due to low-energy mechanisms, especially among elderly patients. We aimed to investigate clinical characteristics and fracture morphology of NMF across age groups.

We retrospectively reviewed trauma patients treated for NMF at a tertiary center from 2014 to 2021. Demographics, diagnosis, trauma mechanisms, admission, and treatment data were collected. Fractures were classified by location and type. Patients were stratified into two age groups: younger (< 65 years) and older (≥ 65 years). Descriptive statistical analysis was performed.

Eighty-six patients (median age 59.5 ± 16.8 years; 64% male; < 65 years, n = 51; ≥ 65 years, n = 35) met inclusion criteria. ICU admission occurred in 65.1%; spinal cord injury was present in 12.8%. High-energy trauma predominated among younger patients (52.9% vs. 25.7%), whereas older patients experienced more low-energy falls (31.4% vs. 7.8%). Of 342 fractures identified, 221 occurred in younger patients; AO type A fractures and fractures in semi-rigid spinal regions were most common. Younger patients had more associated injuries. Overall, surgical treatment was performed in 76.5% of patients without age differences; 14% required revision surgery. Postoperative pneumonia affected 50%, with similar complication rates across age groups.

Despite distinct trauma mechanisms and fracture morphologies between age groups, rates of surgical treatment and postoperative complications were comparable. Age-adapted diagnostic and management strategies for NMF may be beneficial.