Lightning Podiums: Spinal Potpourri - 803B

Presented by: P. Passias

Author(s):

P. Passias(1), G. Poorman(1), F. Segreto(1), C. Jalai(1), S. Horn(1), C. Bortz(1), D. Vasquez-Montes(1), D. Ge(1), N. Stekas(1), B. Diebo(2), S. Vira(1), O. Bono(1), R. De La Garza-Ramos(3), J. Moon(1), C. Wang(4), B. Hirsch(1), P. Zhou(1), M. Gerling(1), H. Koller(5), V. Lafage(6)

(1) New York University Langone Orthopedic Hospital, Division of Spinal Surgery, New York, NY, United States
(2) SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, United States
(3) Bronx-Lebanon Hospital Center, Bronx, NY, United States
(4) Eastern Virginia Medical School, Norfolk, VA, United States
(5) Werner-Wicker-Klinik, Spine Center, Bad Wildungnen, Germany
(6) Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, NY, United States

Abstract

Introduction: The etiologies and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, etiology, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures.

Methods: Retrospective review of the Nationwide Inpatient Sample. ICD-9 E-Codes identified trauma cases from 2005-2013. Patients with cervical fracture were isolated. Demographics, incidence, etiology, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. T-tests elucidated significance for continuous variables, chi-square for categorical variables. Level of significance P< 0.05.

Results: 488,262 patients isolated (age:55.96, male:60.0%, white:77.5%). Incidence (2005:4.1% vs 2013:5.4%), Charlson-Comorbidity-Index (2005:0.6150 vs. 2013:1.1178), and total charges (2005:$71,228.60 vs. 2013:$108,119.29) have increased since 2005, while length of stay (LOS) decreased (2005:9.22 vs. 2013:7.86) (all P< 0.05). Most common etiologies were MVA (29.3%), falls (23.7%) and pedestrian accidents (15.7%). Most frequent fracture types were closed at C2 (32.0%) and C7 (20.9%). Concurrent injury rates have significantly increased since 2005 (2005:62.3% vs. 2013:67.6%). Common concurrent injuries included fractures to the rib/sternum/larynx/trachea (19.6%). Overall fusion rates have increased since 2005 (2005:15.7% vs 2013:18.0%), while decompressions and halo insertion rates have decreased (all P< 0.05). SCIs have significantly decreased since 2005, except for upper-cervical central cord syndrome. Complication rates have significantly increased since 2005 (2005:31.6% vs. 2013:36.2%). Common complications included Anemia (7.7%), Mortality (6.6%), and ARDS (6.6%).

Conclusion: Incidence, complications, concurrent injuries, and fusions have increased since 2005. LOS, SCIs, decompressions and halo insertions have decreased. Indicated trends should guide future research in management guidelines.