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As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are frequently faced with difficult decisions regarding the goals of management and the need to discuss prognosis with the patient and their families. Traumatic spinal cord injury can have potentially devastating consequences, particularly in an elderly population. The objectives of this study were to determine the specific factors associated with mortality in the elderly following tSCI and develop a simple clinical tool to predict mortality in the acute setting. A single quaternary spinal referral center. All patients from our prospectively collected database with traumatic SCI aged >65 years, from 2007-2014. The main outcome measure was in-hospital mortality with data also collected on patient demographics, injury factors and treatment course. Prospectively collected data of all elderly patients (≥65 years) within the national Rick Hansen SCI registry from 2004 to 2017 were analyzed using bivariate and multivariate analyses to determine what factors were associated with in-hospital patient mortality. A total of 1,382 patients were divided into three groups: 65-69 years, 70-74 years and ≥75 years of age. Overall in-hospital mortality was 15.8% with 218 deaths. The factors associated with mortality included age, injury severity (AIS grade), level of injury, and ISS. Mortality rates were highest in the most elderly (65-69 yrs 7.8%, 70-74yrs 10.6%, ≥75yrs 24%). Those with AIS A injuries had a mortality of 30.6% (OR 6.0, p <0.001). High cervical SCI had a much higher rate of mortality than low cervical (18.4% vs 12.7%, p 0.001) and ISS >25 was strongly associated with mortality (p<0.0001). In the 614 patients ≥75 years, in-hospital mortality was 49% for ASIA A, 29% for high cervical injury, and 20% for low cervical injury. Those with an ISS > 25 were twice as likely to die in hospital. Of the survivors, only 37% were discharged home. Increasing age, level of injury and AIS grade are strongly associated with mortality in elderly tSCI patients. Using these factors, we can establish a tool for predicting in-patient mortality that may help surgeons with decision-making around goals of management and with communication of prognosis to patients and their families. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

Study Design: Questionnaires administered to practicing orthopedic and neurosurgical spine surgeons from various regions of the United States and abroad., Objectives: To determine similarities and differences in the treatment of spinal trauma., Summary of Background Data: Spinal trauma is generally referred to subspecialists of orthopedic or neurosurgical training. Prior studies have suggested that there is significant variability in the management of such injuries., Methods: Questionnaires based on eight clinical scenarios of commonly encountered cervical, thoracic, and lumbar injuries were administered to 35 experienced spinal surgeons. Surgeons completed profile information and answered approximately one dozen questions for each case. Data were analyzed with SPSS software to determine the levels of agreement and characteristics of respondents that might account for a lack of agreement on particular aspects of management., Results: Of the 35 surgeons completing the questionnaire, 63% were orthopedists, 37% were neurosurgeons, and 80% had been in practice for more than 5 years. Considerable agreement was found in the majority of clinical decisions, including whether or not to operate and the timing of surgery. Of the differences noted, neurosurgeons were more likely to obtain a MRI, and orthopedists were more likely to use autograft as a sole graft material. Physicians from abroad were, in general, more likely to operate and to use an anterior approach during surgery than physicians from the northeastern United States., Conclusions: More commonalities were identified in the management of spinal trauma than previously reported. When found, variability in opinion was related to professional and regional differences.