What Is the Epidemiology of Cervical and Thoracic Spine Fractures?

BACKGROUND: Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. QUESTION/PURPOSE: What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? METHODS: The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. RESULTS: The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. CONCLUSION: This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. LEVEL OF EVIDENCE: Level III, prognostic study.

The Geriatric Nutritional Risk Index Is an Independent Predictor for Adverse Outcomes After Anterior Cervical Discectomy and Fusion.

BACKGROUND: Malnutrition frequently is associated with increased complications and worse outcomes after surgery. The purpose of this study was to determine whether malnutrition status determined using the Geriatric Nutritional Risk Index (GNRI) can serve as an independent risk factor for complications in patients undergoing anterior cervical discectomy and fusion (ACDF). METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2011 to 2016 for patients age ≥65 years who underwent ACDF. Patients were categorized into 3 groups based on the GNRI: >98, normal nutritional status; 92-98, moderately malnourished; and <92, severely malnourished. Multivariate logistic regression models adjusted for covariates of demographics, comorbidities, and operative metrics were used to evaluate GNRI as an independent risk factor for postoperative outcomes. RESULTS: A total of 3148 patients who underwent ACDF were analyzed, of whom 78.9% had normal nutrition, 16.1% were moderately malnourished, and 5.0% patients were severely malnourished. On multivariate analysis, moderate and severe malnutrition were found to be independent risk factors for any complication, pulmonary complications, pneumonia, unplanned intubation, and hospital length of stay >6 days (P < 0.05 for all). In addition, moderate malnutrition was a risk factor for failure to wean from ventilation for >48 hours and 30-day readmission. Severe malnutrition was an independent risk factor for septic shock and nonhome discharge. CONCLUSIONS: In elderly patients after ACDF, malnutrition determined using GNRI is an independent risk factor for 30-day complications, readmissions, prolonged hospital length of stay, and nonhome discharge.

Single-Stage versus Multi-Stage Intramedullary Nailing for Multiple Synchronous Long Bone Impending and Pathologic Fractures in Metastatic Bone Disease and Multiple Myeloma.

PURPOSE: Determine whether perioperative outcomes differ between patients who have undergone single or multi-stage IMN procedures for impending or completed pathologic fractures. METHODS: Patients were classified into single-stage single-bone (SSSB), single-stage multiple-bone (SSMB), and multi-stage multiple-bone (MSMB) based on procedure timing and number of bones involved. Outcome variables compared included length of stay (LOS), in-hospital mortality and survival, initiation of rehabilitation and adjuvant therapy, and perioperative complications. RESULTS: There were 272 IMNs placed in 181 patients (100 males, 81 females, 55.2% and 44.8%, respectively) with a mean age of 66.3 ± 12.1 years. MSMB had significantly longer LOS (24.3 ± 14.2 days) and rehabilitation initiation (3.4 ± 2.5 days) compared to SSSB (8.5 ± 7.7 and 1.8 ± 1.6 days) and SSMB (11.5 ± 7.6 and 2.0 ± 1.6 days) subjects, respectively (both; p < 0.01). Although total perioperative complication rates in SSMB and MSMB were comparable (33.3% vs. 36.0%), they were significantly higher than SSSB (18%) (p = 0.038). MSMB had significantly more (20%) cardiopulmonary complications than SSMB (11.1%) and SSSB (4.5%) (p = 0.027). All groups exhibited comparative survivorship (8.1 ± 8.6, 7.1 ± 7.2, and 11.4 ± 11.8 months) and in-hospital mortality (4.5%, 8.9%, and 4.0%) (all; p > 0.05). CONCLUSION: In comparison to MSMB, SSMB intramedullary nailing did not result in higher perioperative complication or in-hospital mortality rates in select patients with synchronous long-bone metastases but led to earlier postoperative discharge and initiation of rehabilitation.

Efficacy of Accessory Facet Views in the Detection of Occult Patellar Malreduction: A Biomechanical Analysis.

A simulated fracture model was used to determine the ability of the medial and lateral patellar facet views in detecting magnitudes of articular displacement. Transverse patellar fractures were simulated in ten patients. Medial and lateral translation of the distal fragment were evaluated in 1 mm increments and rotational malalignment along the longitudinal axis of the patella was evaluated in 5 mm increments. In comparison to the true lateral view, the utilization of the medial and lateral patellar facet views considerably improves detection of occult articular surface malreduction.