Introduction: Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. Here, we sought to characterize the morbidity and mortality associated with traumatic fractures of the lumbar spine in the elderly.
Methods: Using the National Sample Program of the National Trauma Data Bank, we performed a retrospective analysis of patients with age = 55 years and traumatic fracture to the lumbar spine. Univariate and multivariable analyses were utilized to characterize and identify predictors of several outcome parameters -- medical and surgical complications, mortality, length of stay (LOS), ICU LOS, ventilated days, and discharge deposition.
Results: From 2003-2012, 22,835 people met inclusion criteria which represents 94,103 incidents nationally. The most prevalent medical complications were pneumonia (7.0%), acute respiratory distress syndrome (3.6%), and deep venous thrombosis (3%). Surgical site infections occurred in 6.3% of cases. Instrumented surgery was associated with highest odds of each complication (p < 0.001). The inpatient mortality rate was 6.8%. Multivariable analyses demonstrated age = 70 years old was an independent predictor of mortality (multivariate odds ratio (OR) 3.16, 95% CI [2.77-3.60]). Instrumented surgery (multivariate OR 0.38, 95% CI [0.28-0.52]) and vertebroplasty / kyphoplasty (multivariate OR 0.27, 95% CI [0.17-0.45]) were associated with decreased odds of death. In surviving patients, both older age (multivariate OR 0.32, 95 % CI [0.30-0.34]) and instrumented fusion (multivariate OR 0.83, 95% CI [0.72-0.95]) were associated with decreased odds of discharge to home.
Conclusions: Lumbar surgery in the elderly is associated with increased morbidity. Instrumented fusion is associated with peri-procedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings.
Patient Care: It provides an evidence base for risk/benefit discussions for several operative techniques utilized in traumatic lumbar fractures in the elderly. It also identifies areas of postoperative care which may be further optimized to reduce morbidity.
Learning Objectives: By the conclusion of the session, participants should be able to: 1) describe the complication profile for operative and non-operative management of traumatic lumbar fractures in the elderly; 2) identify areas of postoperative care which may be further optimized to reduce medical complications in this population; 3) provide evidence-based risks and benefits of different operative techniques in this population.