Purpose of the study: Cases of serious trauma to the cervical spine requiring surgical management in older subjects goes in hand with the general trend towards a more active elderly population. We analyzed retrospectively our experience with 28 patients cared for in our unit from 1990 to 1999.

Patients and methods: Mean age of these 11 women and 17 men was 73 years (range 65–93). High-energy trauma was the cause of the cervical injury in 12 patients (42%). The others were victims of falls in their homes. This later cause explains the long delay to care (21 days on the average with a range from zero days to six months). The six patients who had injuries to the upper cervical spine had fractures of the odontoid process secondary to a fall. The mobile segment of the spine was involved in most of the injuries involving the lower cervical spine (eleven severe sprains and six dislocations) resulting from high-energy trauma in half of the cases. These injuries occurred above an osteoarthritic block. Half of the patients had neurological complications: eleven immediate, three late. The Franckel classification was: A=2, C=4, D=7. The same repair technique was used for the upper an lower cervical spine. Five of the six fractures of the odontoid process were fixed with a Bölher screw, and one with posterior fusion. An anterior graft with plate fixation was used 18 times for the lower spine. Roy Camille posterior fixation was used four times because of the irreducible nature of the fracture or because of the need for posterior fusion.

Results: Morbidity was high. Seven patients (25%) had serious cardiorespiratory complications leading to death in five patients. All these patients had neurological sequelae (Franckel A and C). For the other patients, the postoperative period was uneventful and similar to that observed in younger patients (immobilization, neurological recovery, consolidation).

Discussion: The high frequency of upper cervical spine trauma observed in our series is also reported in the literature. It increases with age. The frequency of neurological involvement was identical to that observed by Roth and Spivak. Prognosis was poor in case of neurological involvement. The appropriateness of surgery in Franckel A patients may be questionable. Surgery cannot avoid the risk of mortality in these patients but it can enable mobilisation and nursing care, avoiding the need for a halo jacket.

Conclusion: Spinal trauma in the elderly can be managed similarly to that in young adults, at least in cases without major neurological involvement.