Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013

Peter G. Passias, Gregory W. Poorman, Frank A. Segreto, Cyrus M. Jalai, Samantha R. Horn, Cole A. Bortz, Dennis Vasquez-Montes, Bassel G. Diebo, Shaleen Vira, Olivia J. Bono, Rafael De La Garza-Ramos, John Y. Moon, Charles Wang, Brandon P. Hirsch, Peter L. Zhou, Michael Gerling, Heiko Koller, Virginie Lafage

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Objective: The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. Methods: A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ 2 for categorical variables. Level of significance was P < 0.05. Results: A total of 488,262 patients were isolated (age, 55.96 years; 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, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The 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%), whereas 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 acute respiratory distress syndrome (6.6%). Conclusions: Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.

Original languageEnglish (US)
Pages (from-to)e427-e437
JournalWorld Neurosurgery
Volume110
DOIs
StatePublished - Feb 2018
Externally publishedYes

Fingerprint

Spine
Spinal Cord Injuries
Incidence
Wounds and Injuries
Decompression
Accidents
Central Cord Syndrome
Length of Stay
Demography
Rib Fractures
Closed Fractures
Sternum
Intraoperative Complications
Adult Respiratory Distress Syndrome
International Classification of Diseases
Motor Vehicles
Larynx
Trachea
Comorbidity
Anemia

Keywords

  • Cervical spine
  • Cervical spine fracture
  • Epidemiology
  • Etiology
  • Fracture
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Traumatic Fractures of the Cervical Spine : Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. / Passias, Peter G.; Poorman, Gregory W.; Segreto, Frank A.; Jalai, Cyrus M.; Horn, Samantha R.; Bortz, Cole A.; Vasquez-Montes, Dennis; Diebo, Bassel G.; Vira, Shaleen; Bono, Olivia J.; De La Garza-Ramos, Rafael; Moon, John Y.; Wang, Charles; Hirsch, Brandon P.; Zhou, Peter L.; Gerling, Michael; Koller, Heiko; Lafage, Virginie.

In: World Neurosurgery, Vol. 110, 02.2018, p. e427-e437.

Research output: Contribution to journalArticle

Passias, PG, Poorman, GW, Segreto, FA, Jalai, CM, Horn, SR, Bortz, CA, Vasquez-Montes, D, Diebo, BG, Vira, S, Bono, OJ, De La Garza-Ramos, R, Moon, JY, Wang, C, Hirsch, BP, Zhou, PL, Gerling, M, Koller, H & Lafage, V 2018, 'Traumatic Fractures of the Cervical Spine: Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013', World Neurosurgery, vol. 110, pp. e427-e437. https://doi.org/10.1016/j.wneu.2017.11.011
Passias, Peter G. ; Poorman, Gregory W. ; Segreto, Frank A. ; Jalai, Cyrus M. ; Horn, Samantha R. ; Bortz, Cole A. ; Vasquez-Montes, Dennis ; Diebo, Bassel G. ; Vira, Shaleen ; Bono, Olivia J. ; De La Garza-Ramos, Rafael ; Moon, John Y. ; Wang, Charles ; Hirsch, Brandon P. ; Zhou, Peter L. ; Gerling, Michael ; Koller, Heiko ; Lafage, Virginie. / Traumatic Fractures of the Cervical Spine : Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013. In: World Neurosurgery. 2018 ; Vol. 110. pp. e427-e437.
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abstract = "Objective: The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. Methods: A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ 2 for categorical variables. Level of significance was P < 0.05. Results: A total of 488,262 patients were isolated (age, 55.96 years; 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, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3{\%}), falls (23.7{\%}), and pedestrian accidents (15.7{\%}). The 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{\%}), whereas 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 acute respiratory distress syndrome (6.6{\%}). Conclusions: Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.",
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TY - JOUR

T1 - Traumatic Fractures of the Cervical Spine

T2 - Analysis of Changes in Incidence, Cause, Concurrent Injuries, and Complications Among 488,262 Patients from 2005 to 2013

AU - Passias, Peter G.

AU - Poorman, Gregory W.

AU - Segreto, Frank A.

AU - Jalai, Cyrus M.

AU - Horn, Samantha R.

AU - Bortz, Cole A.

AU - Vasquez-Montes, Dennis

AU - Diebo, Bassel G.

AU - Vira, Shaleen

AU - Bono, Olivia J.

AU - De La Garza-Ramos, Rafael

AU - Moon, John Y.

AU - Wang, Charles

AU - Hirsch, Brandon P.

AU - Zhou, Peter L.

AU - Gerling, Michael

AU - Koller, Heiko

AU - Lafage, Virginie

PY - 2018/2

Y1 - 2018/2

N2 - Objective: The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. Methods: A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ 2 for categorical variables. Level of significance was P < 0.05. Results: A total of 488,262 patients were isolated (age, 55.96 years; 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, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The 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%), whereas 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 acute respiratory distress syndrome (6.6%). Conclusions: Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.

AB - Objective: The causes and epidemiology of traumatic cervical spine fracture have not been described with sufficient power or recency. Our goal is to describe demographics, incidence, cause, spinal cord injuries (SCIs), concurrent injuries, treatments, and complications of traumatic cervical spine fractures. Methods: A retrospective review was carried out of the Nationwide Inpatient Sample. International Classification of Disease, Ninth Revision E-codes identified trauma cases from 2005 to 2013. Patients with cervical fracture were isolated. Demographics, incidence, cause, fracture levels, concurrent injuries, surgical procedures, and complications were analyzed. t tests elucidated significance for continuous variables and χ 2 for categorical variables. Level of significance was P < 0.05. Results: A total of 488,262 patients were isolated (age, 55.96 years; 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, whereas length of stay decreased (2005, 9.22 vs. 2013, 7.86) (all P < 0.05). The most common causes were motor vehicle accident (29.3%), falls (23.7%), and pedestrian accidents (15.7%). The 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%), whereas 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 acute respiratory distress syndrome (6.6%). Conclusions: Incidence, complications, concurrent injuries, and fusions have increased since 2005. Length of stay, SCIs, decompressions, and halo insertions have decreased. Indicated trends should guide future research in management guidelines.

KW - Cervical spine

KW - Cervical spine fracture

KW - Epidemiology

KW - Etiology

KW - Fracture

KW - Trauma

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