260. Comparing outcomes and mortality of upper cervical and subaxial cervical spine trauma in elderly patients

BACKGROUND CONTEXT In contrast to younger patients, the elderly are more likely to sustain severe cervical spine trauma from relatively low energy mechanisms of injury. The presence of preexisting spine pathology such as osteoporosis, cervical stenosis, ankylosis, spondylosis, and degenerative changes can predispose elderly patients to fractures and neurologic injury in both the upper and subaxial cervical spine. PURPOSE To date, there has been little research comparing outcomes and mortality rates of patients with upper cervical (occiput-C2) versus subaxial (C3-C7) cervical spine injuries. Given the paucity of data on this subject, this current study compares mortality rates and outcomes between elderly patients with upper cervical and subaxial cervical spine injuries using our prospective trauma database. STUDY DESIGN/SETTING Using data extracted from our clinical trauma registry, we conducted a single center retrospective cohort study. Retrospective chart review was performed to assess treatment rendered, complications, and outcome measures and then stored in a deidentified database. PATIENT SAMPLE All elderly (65+) trauma patients with cervical spine injuries who presented to a single, high-volume, level I trauma center between 2010-2019 were identified. OUTCOME MEASURES Outcomes such as medical and surgical complication rates, length of hospitalization, and mortality at various time points were collected. METHODS Imaging characteristics of patients including psoas index (a marker for sarcopenia) and L3 Hounsfield Unit (an indicator of osteoporosis) were calculated using standard technique and recorded into the database. Patients with cervical spine trauma were sorted into upper cervical (occipital condyle, C1, and C2 vertebral fractures and ligamentous injuries) and subaxial (C3-7) cohorts and by treatment (operative vs nonoperative management). Surgical and medical morbidity variables recorded include surgical site infection, pneumonia, STEMI, DVT/PE and stroke. Pearson's Chi-squared tests were used to compare rates of mortality and complications between groups. RESULTS A total of 922 patients were identified, with 545 upper cervical (59%), and 377 subaxial (41%) trauma patients. Patients with upper cervical spine trauma were significantly older (p CONCLUSIONS Although patients with subaxial injuries were found to be more severely traumatized with higher energy mechanisms and more severe associated injuries, our data demonstrate that patients with upper cervical trauma are at higher risk for medical and surgical complication and mortality, regardless of need for operative intervention. This is likely secondary to poor reserve given their older age, advanced sarcopenia, and the increased morbidity associated with both operative management and nonoperative immobilization. In conclusion, we have demonstrated in the largest study to date that patients with upper cervical injuries, although less severely traumatized, should be more critically evaluated given their increased risk for morbidity and mortality, which can help guide discussions with the patient and family about expected outcomes and functional status. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.