Spinal cord injury (SCI) in elderly patients is increasingly common. The mechanism of trauma and patterns of SCI differ from those in younger patients. Additionally, the high prevalence of degenerative changes and stenosis in the elderly population may influence the clinical presentation and treatment patterns. Systemic medical issues and severity of neurological injury may contribute to the extremely high mortality rate in elderly patients. The elderly patients who survive SCI have the potential for meaningful functional and neurological recovery and require directed rehabilitation to this end.

US Social Security Administration. OASDI Trustees Report; 2007.
Spivak JM, Weiss MA, Cotler JM, Call M. Cervical spine injuries in patients 65 and older.Spine. 1994;19(20):2302–2306.
,
Cervical spine injuries in patients 65 and older
,
Spine.
, vol.
19
(pg.
2302
-
2306
)
Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism.J Trauma. 2001;50(1):116–119.
,
Geriatric falls: injury severity is high and disproportionate to mechanism
,
J Trauma.
, vol.
50
(pg.
116
-
119
)
Jackson AB, Dijkers M, Devivo MJ, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years.Arch Phys Med Rehabil. 2004;85(11):1740–1748.
,
A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years
,
Arch Phys Med Rehabil.
, vol.
85
(pg.
1740
-
1748
)
Hagen EM, Aarli JA, Gronning M. The clinical significance of spinal cord injuries in patients older than 60 years of age.Acta Neurol Scand. 2005;112(1):42–47.
,
The clinical significance of spinal cord injuries in patients older than 60 years of age
,
Acta Neurol Scand.
, vol.
112
(pg.
42
-
47
)
Chen TY, Dickman CA, Eleraky M, Sonntag VK. The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis.Spine. 1998;23(22):2398–2403.
,
The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis
,
Spine.
, vol.
23
(pg.
2398
-
2403
)
Toussirot E, Wendling D. Late-onset ankylosing spondylitis and related spondylarthropathies: clinical and radiological characteristics and pharmacological treatment options.Drugs Aging. 2005;22(6):451–469.
,
Late-onset ankylosing spondylitis and related spondylarthropathies: clinical and radiological characteristics and pharmacological treatment options
,
Drugs Aging.
, vol.
22
(pg.
451
-
469
)
Whang PG, Goldberg G, Lawrence JP, et al. The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes.J Spinal Disord Tech. 2009;22(2):77–85.
,
The management of spinal injuries in patients with ankylosing spondylitis or diffuse idiopathic skeletal hyperostosis: a comparison of treatment methods and clinical outcomes
,
J Spinal Disord Tech.
, vol.
22
(pg.
77
-
85
)
Fassett DR, Harrop JS, Maltenfort M, et al. Mortality rates in geriatric patients with spinal cord injuries. JNeurosurg Spine. 2007;7(3):277–281.
,
Mortality rates in geriatric patients with spinal cord injuries. J
,
Neurosurg Spine.
, vol.
7
(pg.
277
-
281
)
Lomoschitz FM, Blackmore CC, Mirza SK, Mann FA. Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries.Am J Roentgenol. 2002;178(3):573–577.
,
Cervical spine injuries in patients 65 years old and older: epidemiologic analysis regarding the effects of age and injury mechanism on distribution, type, and stability of injuries
,
Am J Roentgenol.
, vol.
178
(pg.
573
-
577
)
Sokolowski MJ, Jackson AP, Haak MH, Meyer PR Jr, Sokolowski MS. Acute mortality and complications of cervical spine injuries in the elderly at a single tertiary care center.J Spinal Disord Tech. 2007;20(5):352–356.
,
Acute mortality and complications of cervical spine injuries in the elderly at a single tertiary care center
,
J Spinal Disord Tech.
, vol.
20
(pg.
352
-
356
)
Sokolowski MJ, Jackson AP, Haak MH, Meyer PR Jr, Szewczyk Sokolowski M. Acute outcomes of cervical spine injuries in the elderly: atlantaxial vs subaxial injuries.J Spinal Cord Med. 2007;30(3):238–242.
,
Acute outcomes of cervical spine injuries in the elderly: atlantaxial vs subaxial injuries
,
J Spinal Cord Med.
, vol.
30
(pg.
238
-
242
)
Berlemann U, Schwarzenbach O. Dens fractures in the elderly. Results of anterior screw fixation in 19 elderly patients.Acta Orthop Scand. 1997;68(4):319–324.
,
Dens fractures in the elderly. Results of anterior screw fixation in 19 elderly patients
,
Acta Orthop Scand.
, vol.
68
(pg.
319
-
324
)
Malik SA, Murphy M, Connolly P, O’Byrne J. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients.Eur Spine J. 2008;17(4):585–591.
,
Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients
,
Eur Spine J.
, vol.
17
(pg.
585
-
591
)
Majercik S, Tashjian RZ, Biffl WL, Harrington DT, Cioffi WG. Halo vest immobilization in the elderly: a death sentence?J Trauma. 2005;59(2):350–356; discussion 356–358.
,
Halo vest immobilization in the elderly: a death sentence?
,
J Trauma.
, vol.
59
(pg.
350
-
356
)
Tashjian RZ, Majercik S, Biffl WL, Palumbo MA, Cioffi WG. Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures.J Trauma. 2006;60(1):199–203.
,
Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures
,
J Trauma.
, vol.
60
(pg.
199
-
203
)
Pitzen TR, Drumm J, Bruchmann B, Barbier DD, Steudel WI. Effectiveness of cemented rescue screws for anterior cervical plate fixation.J Neurosurg Spine. 2006;4(1):60–63.
,
Effectiveness of cemented rescue screws for anterior cervical plate fixation
,
J Neurosurg Spine.
, vol.
4
(pg.
60
-
63
)
Burval DJ, McLain RF, Milks R, Inceoglu S. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength.Spine. 2007;32(10):1077–1083.
,
Primary pedicle screw augmentation in osteoporotic lumbar vertebrae: biomechanical analysis of pedicle fixation strength
,
Spine.
, vol.
32
(pg.
1077
-
1083
)
Glassman SD, Alegre GM. Adult spinal deformity in the osteoporotic spine: options and pitfalls.Instr Course Lect. 2003;52:579–588.
,
Adult spinal deformity in the osteoporotic spine: options and pitfalls
,
Instr Course Lect.
, vol.
52
(pg.
579
-
588
)
Goktepe AS, Tugcu I, Yilmaz B, Alaca R, Gunduz S. Does standing protect bone density in patients with chronic spinal cord injury?J Spinal Cord Med. 2008;31(2):197–201.
,
Does standing protect bone density in patients with chronic spinal cord injury?
,
J Spinal Cord Med.
, vol.
31
(pg.
197
-
201
)
Robertson BD, Robertson TJ. Postoperative delirium after hip fracture.J Bone Joint Surg Am. 2006;88(9):2060–2068.
,
Postoperative delirium after hip fracture
,
J Bone Joint Surg Am.
, vol.
88
(pg.
2060
-
2068
)
Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture.J Gerontol A Biol Sci Med Sci. 2003;58(1):76–81.
,
Relationship between pain and opioid analgesics on the development of delirium following hip fracture
,
J Gerontol A Biol Sci Med Sci.
, vol.
58
(pg.
76
-
81
)
Furlan JC, Kattail D, Fehlings M. The impact of co-morbidities on age-related differences in mortality after acute traumatic spinal cord injury.J Neurotrauma. 2009;26(8):1361–1367.
,
The impact of co-morbidities on age-related differences in mortality after acute traumatic spinal cord injury
,
J Neurotrauma.
, vol.
26
(pg.
1361
-
1367
)
Krassioukov AV, Furlan JC, Fehlings MG. Medical co-morbidities, secondary complications, and mortality in elderly with acute spinal cord injury.J Neurotrauma. 2003;20(4):391–399.
,
Medical co-morbidities, secondary complications, and mortality in elderly with acute spinal cord injury
,
J Neurotrauma.
, vol.
20
(pg.
391
-
399
)
DeVivo MJ, Kartus PL, Stover SL, Rutt RD, Fine PR. Seven-year survival following spinal cord injury.Arch Neurol. 1987;44(8):872–875.
,
Seven-year survival following spinal cord injury
,
Arch Neurol.
, vol.
44
(pg.
872
-
875
)
DeVivo MJ. Sir Ludwig Guttmann Lecture: trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006.Spinal Cord. 2007;45(11):713–721.
,
Sir Ludwig Guttmann Lecture: trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006
,
Spinal Cord.
, vol.
45
(pg.
713
-
721
)
Scivoletto G, Morganti B, Ditunno P, Ditunno JF, Molinari M. Effects on age on spinal cord lesion patients’ rehabilitation.Spinal Cord. 2003;41(8):457–464.
,
Effects on age on spinal cord lesion patients’ rehabilitation
,
Spinal Cord.
, vol.
41
(pg.
457
-
464
)
McKinley W, Cifu D, Seel R, et al. Age-related outcomes in persons with spinal cord injury: a summary paper.NeuroRehabilitation. 2003;18(1):83–90.
,
Age-related outcomes in persons with spinal cord injury: a summary paper
,
NeuroRehabilitation.
, vol.
18
(pg.
83
-
90
)
Aito S, D’Andrea M, Werhagen L, et al. Neurological and functional outcome in traumatic central cord syndrome.Spinal Cord. 2007;45(4):292–297.
,
Neurological and functional outcome in traumatic central cord syndrome
,
Spinal Cord.
, vol.
45
(pg.
292
-
297
)
Jakob W, Wirz M, van Hedel HJ, Dietz V. Difficulty of elderly SCI subjects to translate motor recovery -”body function”- into activity of daily living.J Neurotrauma. Jul 15 2009. Epub ahead of print.
,
Difficulty of elderly SCI subjects to translate motor recovery -”body function”- into activity of daily living
,
J Neurotrauma.
Furlan JC, Fehlings M. The impact of age on mortality, impairment and disability among adults with acute traumatic spinal cord injury.J Neurotrauma. 2009; 26(10):1707–1717.
,
The impact of age on mortality, impairment and disability among adults with acute traumatic spinal cord injury
,
J Neurotrauma.
, vol.
26
(pg.
1707
-
1717
)
Lieberman IH, Webb JK. Cervical spine injuries in the elderly.J Bone Joint Surg Br. 1994;76(6):877–881.
,
Cervical spine injuries in the elderly
,
J Bone Joint Surg Br.
, vol.
76
(pg.
877
-
881
)
Harrop JS, Sharan AD, Scheid EH Jr, Vaccaro AR, Przybylski GJ. Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A.J Neurosurg. 2004;100(1 Suppl Spine):20–23.
,
Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A
,
J Neurosurg.
, vol.
100
(pg.
20
-
23
)
Levy RN. Does cost containment create conflict in the care of the elderly patient?Clin Orthop Relat Res. 2000(378):66–70.
,
Does cost containment create conflict in the care of the elderly patient?
,
Clin Orthop Relat Res.
, vol.
(378)
(pg.
66
-
70
)
Pritchard KI. Have we been guilty of ageism in the primary treatment of breast cancer?Br J Cancer. 2007;96(7):1011–1012.
,
Have we been guilty of ageism in the primary treatment of breast cancer?
,
Br J Cancer.
, vol.
96
(pg.
1011
-
1012
)
Ausman JI. Therapeutic nihilism and the elderly.Surg Neurol. 2008;69(5):546–547.
,
Therapeutic nihilism and the elderly
,
Surg Neurol.
, vol.
69
(pg.
546
-
547
)
Fehlings MG, Furlan JC. Effect of age on spinal cord injury.J Neurosurg Spine. 2007;7(3):275–276; discussion 276.
,
Effect of age on spinal cord injury
,
J Neurosurg Spine.
, vol.
7
(pg.
275
-
276
)
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