Surgical management of cervical spinal cord injury in extremely elderly patients, aged 80 or older

• Main Authors: Koki Kato, Kazunari Fushimi, Satoshi Nozawa, Chizuo Iwai, Takahiro Masuda, Akira Hioki, Kei Miyamoto, Tetsuya Shimokawa, Haruhiko Akiyama
• Format: Article
• Language: English
• Published: Elsevier 2021-03-01
• Series: Interdisciplinary Neurosurgery
• Subjects: Spinal cord injury; Cervical spine; Elderly; Surgery
• Online Access: http://www.sciencedirect.com/science/article/pii/S2214751920305016

Aim: Spinal cord injury in elderly populations has increased in recent years. This study aimed to investigate the pathology, severity, efficacy of the surgery, and complications of cervical spinal cord injury in extremely elderly patients aged >80 years. Methods: Sixty-three patients who underwent surgical treatment for cervical spinal cord injury were enrolled in this retrospective multicenter study. Forty patients were aged <80 years (Group 1), and 23 patients were aged ≥80 years (Group 2). The etiology of the injury, American Spinal Injury Association impairment scale (AIS) grade, surgical procedure, neurological improvement, and surgical complications were evaluated. Results: Most causes of injury in extremely elderly patients were of low-energy impact. The prevalence of vertebral fracture/dislocation was low and neurological impairment was milder in these patients, than in younger patients. Although overall neural recovery was similar in both groups, patients with complete motor paralysis did not show any improvement in AIS grade in the older group. The mortality rate was the same between the groups. Complication rates in surgical treatment were similar in both groups, with a high incidence of respiratory disorder (average 19%). Respiratory complications were noted during the perioperative period. Conclusions: Surgical treatment of cervical spinal cord injury in extremely elderly patients can be performed safely, with a similar neurological recovery and low rate of surgical complications as those in younger patients. Respiratory complications should be attended to in the perioperative period. Early ambulation after admission coupled with strict respiratory management is probably essential to prevent complications and mortality.