Highlights from #EAST2014 - Spine fractures in the elderly

It appears that full spine imaging is still useful in elderly patients after ground level falls.

IS FULL SPINE IMAGING NECESSARY IN THE ELDERLY, FALL FROM STANDING TRAUMA PATIENT WITH A CERVICAL FRACTURE?

George Koenig, DO, MS*, Niels Martin, MD, FACS, Muhammad Zubair, MBBS, Kris R. Kaulback, MD*, Gary A. Lindenbaum, MD, FACS, FCCP*, Alec Beekley, MD Thomas Jefferson University

Presenter: George Koenig, DO, MS

Discussant: Jamie J. Coleman, MD, Indiana University

Objectives: The incidence of non-contiguous (NC) spinal column fractures approaches 20%. Current practice in the evaluation of patients that sustain cervical spine fractures often involves full spine imaging using computed tomography (CT) to identify concomitant thoraco-lumbar spinal column fractures. We hypothesize that the incidence and clinical relevance of these fractures in elderly patients that fall from standing is low and question if routine CT imaging of the entire spine is necessary.

Methods: We performed a retrospective analysis of patients, older than 65, who fell from standing and sustained a cervical spine fracture in the Pennsylvania Trauma Outcome Study (PTOS) registry. Demographics, frequency of NC spinal fractures, and management were analyzed. Stepwise logistic regression controlled for GCS, ISS, gender, rib fractures, and visceral injuries was used to determine factors associated with NC vertebral fractures.

Results: In total, 14,502 patients met the inclusion criteria of age greater than 65 with the mechanism fall from standing. The incidence of cervical fracture was 7.6%. There was no neurologic deficit in 1083 (98.7%) patients. Within this cohort, 74 (6.8%) were diagnosed with a cervical spine fracture and other spinal column fractures. Three patients required surgery on their thoraco-lumbar spine. The presence of rib fracture was associated with a 2.83 (95% CI:1.46-5.46) increased risk of NC vertebral fracture.

Conclusions: The incidence of NC spinal column fractures is substantially less in elderly that fall from standing than previously reported in other more heterogeneous series of trauma patients. Neither physical exam nor the presence of other injuries reliably predicts who should undergo radiographic screening of their entire
spine. Routine screening for concomitant thoraco-lumbar spinal fractures should not be abandoned especially in patients with associated rib fractures.