A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients
Authors: Sasagawa Takeshi , Yokogawa Noriaki , Hayashi Hiroyuki , Tsuchiya Hiroyuki , Ando Kei , Nakashima Hiroaki , Segi Naoki , Watanabe Kota , Nori Satoshi , Takeda Kazuki , Furuya Takeo , Yunde Atsushi , Ikegami Shota , Uehara Masashi , Suzuki Hidenori , Imajo Yasuaki , Funayama Toru , Eto Fumihiko , Yamaji Akihiro , Hashimoto Ko , Onoda Yoshito , Kakutani Kenichiro , Kakiuchi Yuji , Suzuki Nobuyuki , Kato Kenji , Terashima Yoshinori , Hirota Ryosuke , Yamada Tomohiro , Hasegawa Tomohiko , Kawaguchi Kenichi , Haruta Yohei , Seki Shoji , Tonomura Hitoshi , Sakata Munehiro , Uei Hiroshi , Sawada Hirokatsu , Tominaga Hiroyuki , Tokumoto Hiroto , Kaito Takashi , Iizuka Yoichi , Takasawa Eiji , Oshima Yasushi , Terai Hidetomi , Tamai Koji , Otsuki Bungo , Miyazaki Masashi , Nakajima Hideaki , Nakanishi Kazuo , Misaki Kosuke , Inoue Gen , Kiyasu Katsuhito , Akeda Koji , Takegami Norihiko , Yoshii Toshitaka , Ishihara Masayuki , Okada Seiji , Aoki Yasuchika , Harimaya Katsumi , Murakami Hideki , Ishii Ken , Ohtori Seiji , Imagama Shiro , Kato Satoshi 
Published: August 2022

Abstract
Background
The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older.

Methods
Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients’ backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted.

Results
One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively.

Conclusions
The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.