Cervical spine fractures in the elderly: are there missed opportunities for prevention?

Abstract

Background: The most common site of cervical spine fracture in the elderly is the odontoid process. These fractures result predominantly from ground level falls. Osteoporosis has been identified as an important predisposing risk factor. Objective: This study aimed to evaluate the management of older patients with cervical spine fractures and identify opportunities to reduce fracture rates. Methods: A service evaluation was undertaken utilising a retrospective review of electronic hospital records at the Royal Devon and Exeter hospital for patients aged 50 years and over who sustained a c-spine fracture over a 4 year period. Patients were identified from CT c-spine reports positive for fracture. Results: 85 patients (mean age: 77.25y, SD±12.70) were identified. 61.2% sustained c-spine fractures from a ground level fall. Prior to fracture 11.8% had a DXA scan, 12.9% diagnosed osteoporosis and 9.4% has bisphosphonate use recorded. 41.2% had sustained at least one previous fracture of any bone and 20% prior vertebral fractures. Radiographic osteopenia was mentioned in imaging reports, prior to or on the day of c-spine fracture, in 17.6%. Mortality at 3 and 12 months were 11.8% and 20.8% respectively. One year following c-spine fracture, a further 5 people had a DXA and 1 more person was taking a bisphosphonate. Five people attended the hospital with a fracture within a year of the c-spine fracture, four of which were NOF fractures. Discussion: Mortality rates are similar to those published in other studies. Opportunities for intervention to reduce future fractures were missed after: previous low trauma fractures, reports of radiographic osteopenia and low trauma cervical spine fractures. Fracture prevention is not an integrated part of c-spine fracture care despite their association with osteoporosis in the elderly. In the absence of an FLS, close working of clinical teams is needed to ensure action is taken to reduce fracture rates of cervical spine and other fractures.