Neck injuries are becoming increasingly common in older people. Injuries to the bones in the upper neck (upper cervical spine injuries) can damage the stability of the spinal column, resulting in the potentially life threatening complication of spinal cord injury. These devastating injuries have overall mortality rates of over 30%. In addition, there is substantial morbidity for the survivors, with between 10 to 91% of patients reporting long term deficits.
The primary aim of treating these fractures is to restore normal stability to the spinal column in order to prevent injury to the spinal cord. Options in treating these injuries include the use of a cervical neck brace, an external fixator device (Halo frame) or surgery. Despite the use of different treatment options the incidence of non-union (failure to heal) of these fractures has been reported to be as high as 60%. The incidence of mortality following surgery has been reported to be as high as 40%. The optimal treatment strategy in older patients presenting with upper cervical spine injuries remains controversial.
A prospectively collected database of all patients referred to the National Spinal Injuries Unit for surgical management was commenced in 2005. This comprises in excess of 8,000 patients. A retrospective review of patients >65 years presenting with upper cervical spine injuries will be undertaken. Outcomes in terms of overall survival, complications, long term morbidity and satisfactory fracture healing will be assessed in order to determine the optimal treatment.
