Impact of age on the injury pattern and survival of people with cervical cord injuries

Abstract

Study design: A retrospective, follow-up study.

Objectives: To differentiate the injury pattern and survival of people with cervical cord injuries with onset at different ages.

Setting: Rehabilitation wards of a university hospital that is a tertiary referral center in Taipei, Taiwan.

Methods: The records of acute and traumatic cervical cord injury patients hospitalized from 1989 to 1997 were reviewed. All subjects received comprehensive rehabilitation programs during hospitalization. Their survival status at the end of follow-up was studied.

Results: Forty-seven of 109 (43.1%) people with cervical cord injuries were 50 years or older at onset. Older patients were more frequently injured by minor falls, resulting in more incomplete quadriplegia. They also showed fewer spinal fractures, and more demonstrated associated spondylosis and ossification of the posterior longitudinal ligament. Eleven (10.2%) subjects were deceased, found by a linkage to a death registration database at the end of follow-up. The significant predictor of survival status at follow-up was older age at injury using Cox proportional hazards model.

Conclusion: Spinal cord injured patients had different injury patterns, demanding different preventative strategies. Those injured at older ages were at higher risk of mortality according to our study.

Sponsorship: This study was supported in part by grants from the National Taiwan University Hospital (89S2005), Taipei, Taiwan.

Spinal Cord (2001) 39, 375–380.

References

  1. 1

    Watson N . Pattern of spinal cord injury in the elderly Paraplegia 1976 14: 36–40

  2. 2

    DeVivo MJ et al. Trends in spinal cord injury demographics and treatment outcomes between 1973 and 1986 Arch Phys Med Rehabil 1992 73: 424–430

  3. 3

    Shingu H et al. A nationwide epidemiological survey of spinal cord injuries in Japan from January 1990 to December 1992 Paraplegia 1995 33: 183–188

  4. 4

    Chen HY et al. A nationwide epidemiological survey of spinal cord injury in geriatric patients in Taiwan Neuroepidemiology 1997 16: 241–247

  5. 5

    Madersbacher G, Oberwalder M . The elderly para- and tetraplegic: special aspects of the urological care Paraplegia 1987 25: 318–323

  6. 6

    Teasell R, Allatt D . Managing the growing number of spinal cord-injuries elderly Geriatrics 1991 46: 78–89

  7. 7

    Subbarao JV et al. Spinal cord dysfunction in older patients–rehabilitation outcomes J Am Paraplegia Society 1987 10: 30–35

  8. 8

    Roth EJ et al. The older adult with a spinal cord injury Paraplegia 1992 30: 520–525

  9. 9

    Kiwerske JE . Injuries to the spinal cord in elderly patients Injury 1992 23: 397–400

  10. 10

    Spivak JM et al. Cervical spine injuries in patients 65 and older Spine 1994 19: 2302–2306

  11. 11

    DeVivo MJ et al. The influence of age at time of spinal cord injury on rehabilitation outcome Arch Neurol 1990 47: 687–691

  12. 12

    Lieberman IH, Webb JK . Cervical spine injuries in the elderly J Bone Joint Surg 1994 76B: 877–881

  13. 13

    Mesard L, Carmody A, Mannarino E, Ruge D . Survival after spinal cord trauma Arch Neurol 1978 35: 78–83

  14. 14

    DeVivo MJ, Stover SL, Black KJ . Prognostic factors for 12-year survival after spinal cord injury Arch Phys Med Rehabil 1992 73: 156–162

  15. 15

    Yeo JD et al. Mortality following spinal cord injury Spinal Cord 1998 36: 329–336

  16. 16

    Krause JS, Sternberg M, Lottes S, Maides J . Mortality after spinal cord injury: an 11-year prospective study Arch Phys Med Rehabil 1997 78: 815–821

  17. 17

    Frankel HL et al. Long-term survival in spinal cord injury: a fifty year investigation Spinal Cord 1998 36: 266–274

  18. 18

    Coll JR, Frankel HL, Charlifue SW, Whiteneck GG . Evaluating neurological group homogeneity in assessing the mortality risk for people with spinal cord injuries Spinal Cord 1998 36: 275–279

  19. 19

    DeJong G, Branch LG, Corcoran PJ . Independent living outcomes in spinal cord injury: multivariate analyses Arch Phys Med Rehabil 1984 65: 66–73

  20. 20

    Yarkony GM, Roth EJ, Heinemann AW, Lovell LL . Spinal cord injury rehabilitation outcome: the impact of age J Clin Epidemiol 1988 41: 173–177

  21. 21

    Penrod LE, Hegde SK, Ditunno JF . Age effect on prognosis for functional recovery in acute, traumatic central cord syndrome Arch Phys Med Rehabil 1990 71: 963–968

  22. 22

    Pentland W, McColl MA, Rosenthal C . The effect of aging and duration of disability on long term health outcomes following spinal cord injury Paraplegia 1995 33: 357–373

  23. 23

    Krause JF et al. Incidence of traumatic spinal cord lesions J Chron Dis 1975 28: 471–492

  24. 24

    American Spinal Cord Injury Association. . Standards for neurological classification of spinal injury patients Chicago: American Spinal Injury Association 1982

  25. 25

    McColl MA et al. Expectations of life and health among spinal cord injured adults Spinal Cord 1997 35: 818–828

  26. 26

    Weingarden SI, Graham PM . Falls resulting in spinal cord injury: patterns and outcomes in an older population Paraplegia 1989 27: 423–427

  27. 27

    Alander DH, Andreychik DA, Stauffer ES . Early outcome in cervical spinal cord injured patients older than 50 years of age Spine 1994 19: 2299–2301

  28. 28

    Levitt MA, Flanders AE . Diagnostic capabilities of magnetic resonance imaging and computed tomography in acute cervical spinal column injury Am J Emerg Med 1991 9: 131–135

  29. 29

    Tsuyama N et al. The ossification of the posterior longitudinal ligament of the spine J Jpn Orthop Assoc 1981 55: 425–440

  30. 30

    Tsai CL, Liu HC, Chen HT . Ossification of the posterior longitudinal ligament of the spine in Chinese J Formosa Med Assoc 1978 77: 678–684

  31. 31

    Matsunaga S et al. The natural course of myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine Clin Orthop 1994 305: 168–177

  32. 32

    Endo S et al. Cervical spinal cord injury associated with ossification of the posterior longitudinal ligament Arch Orthop Trauma Surg 1994 113: 218–221

  33. 33

    Matsunaga S et al. The natural course of myelopathy caused by ossification of the posterior longitudinal ligament in the cervical spine Clin Orthop 1994 305: 168–177

  34. 34

    Alander DH, Parker J, Stauffer ES . Intermediate-term outcome of cervical spinal cord-injured patients older than 50 years of age Spine 1997 22: 1189–1192

  35. 35

    Samsa GP, Patrick CH, Feussner JR . Long-term survival of veterans with traumatic spinal cord injury Arch Neurol 1993 50: 909–914

Download references

Acknowledgements

We would like to thank Dr Chen, Pau-Chung, assistant professor of Institute of Occupational Medicine and Industrial Health, National Taiwan University, for helping within data linkage to the death registration system.

Author information

Correspondence to Y-H Wang.

Rights and permissions

Reprints and Permissions

About this article

Keywords

  • spinal cord injury
  • elderly
  • survival

Further reading