Surgical treatment improves survival of elderly with axis fracture – a national population-based multi-registry cohort study

Publication date: Available online 9 April 2018
Source:The Spine Journal
Author(s): Anna-Lena Robinson, Claes Olerud, Yohan Robinson
Background ContextFractures of the axis (C2) are the most common cervical spinal injuries in the elderly population. Several authors have reported improved survival among elderly patients with C2 fractures when treated surgically.PurposeTo analyze whether surgery improves survival of elderly with C2 fractures.Study Design/ SettingObservational population-based longitudinal multi-registry studyPatient SampleSwedish Patient Registry 1997 to 2014, and Swedish Cause of Death Registry 1997 to 2014Outcome measuresSurvival after C2 fracture according to non-surgical and surgical treatment.MethodsIncluded were all patients treated for the primary diagnosis of C2 fracture (ICD-10: S12.1) at an age ≥70 years, receiving treatment at a healthcare facility. Non-surgical treatment comprises of cervical collar or halo-vest treatment. Surgical treatment was identified in the Swedish patient registry extract using the Swedish classification of procedural codes. Survival was determined using the Kaplan Meier method. Comorbidity was determined using the Charlson Comorbidity Index.ResultsOf the included 3,375 elderly patients with C2 fractures (43% male, aged 83±7 years), 22% were treated surgically. Surgical treatment was assigned based on age, gender and year of treatment. The one-year survival of 2,618 non-surgically treated patients was 72% (n=1,856), and 81% (n=614) for the 757 surgically treated (p<0.001, RRR=11%). Adjusted for age, gender, comorbidity and year of injury, surgically treated patients had greater survival than non-surgically treated patients (HR=0.88, 95% CI: 0.79-0.97). Among those above 88 years of age (95% CI: 85-92), surgical treatment lost its effect on survival.ConclusionsDespite the frailty of elderly patients, the morbidity of cervical external immobilization with a rigid collar seemingly weighs greater than surgical morbidity, even in octogenarians. For those above 88 years of age, non-surgical treatment should be primarily attempted.Trial registrationClinicalTrials.gov #NCT02839057



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