Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital

Abstract

National Longitudinal data of thoracolumbar fracture incidence, trends or mortality rates are lacking. The correlation between admissions and operations of thoracolumbar vertebral fractures has not been investigated. The aim of our nationwide population-based epidemiological study was to analyse the incidence, admissions, operations, and case fatality rate among patients with thoracolumbar vertebral fractures admitted to hospital in Sweden. The Swedish Hospital Discharge Register (SHDR) and the Cause of Death Register (CDR) were linked to determine the incidence of surgical interventions, trends, characteristics of the patients, and case fatality rate for thoracolumbar vertebral fractures based on comprehensive national data. The annual incidence of thoracolumbar fractures was on average 30 per 100,000 inhabitants and did not change considerably during the study period. Among patients younger than 60 years of age the annual incidence was 13 per 100,000 and was twice as high in men compared to women. The proportion operated on was 15%. In the age-group 60 years and older the majority were women. In this group two percent were operated on. However, males were operated on twice as often as women. The 90-day case-fatality rate after surgery was 1.4%. This information may assist health care providers in health care planning. Moreover, these data can also be used for power calculations when planning future clinical studies.

Perioperative morbidity and mortality after lumbar trauma in the elderly

“…18,22 They also offer evidence that measures designed to improve bone mineral density (e.g., vitamin D and calcium supplementation, bisphosphonates, calcitonin, and so on) have the greatest potential for curbing the rapidly rising incidence of elderly traumatic lumbar spine fractures. 23,25 Although potentially helpful in reducing the incidence of lumbar spine fracture, our subgroup analysis demonstrated that a preexisting diagnosis of osteoporosis does not influence outcome following acute traumatic fracture in the elderly. Overall, the incidence of osteoporosis was low in the studied cohort.…”

“…A similar female propensity toward lumbar fractures has been reported in both Asian and Scandinavian countries. 23,42 The female predominance, comparatively milder ISS, and increasing use of vertebroplasty or kyphoplasty with advancing age, probably implicates osteoporosis as a contributing etiological entity. 6,30 From the public health perspective, these findings highlight the importance of ongoing primary prevention efforts to avert falls in the elderly.…”

“…29 Across published reports, the annual fracture incidence ranges from 23 to 90 per 100,000 people, and the age distribution is bimodal, with the first peak being found in young adults between 15 and 29 years of age and the second peak in adults older than 65 years. 3,4,10,12,[23][24][25]34,40 Factors that make the elderly more susceptible to these fractures include lower bone density, 20,43 alterations in vertebral biomechanics, 11,21 and more frequent falls. 38 In individuals ≥ 70 years, the annual fracture incidence exAbbreviAtioNs ARDS = acute respiratory distress syndrome; CCI = Charlson Comorbidity Index; ED = emergency department; GCS = Glasgow Coma Scale; HR = hazard ratio; ISS = Injury Severity Score; LOS = length of stay; NSP = National Sample Program; NTDB = National Trauma Data Bank; SBP = systolic blood pressure.…”

“…23,42 When trended over time, the incidence of these fractures in the elderly is increasing at a rate that outstrips that which is predicted solely by the aging of the population. 25,42 Despite its high incidence and prevalence in the elderly population, little is known about the morbidity, mortality, and complications associated with various management strategies for spinal trauma in this group.…”

Planung, Vorbereitung und Kontrolle bei traumatisch bedingten Eingriffen im Bereich der BWS und LWS

“…Die Inzidenz ist altersabhängig und beträgt bei den unter 60-Jährigen nur 13/100 000. Unter 60 Jahren sind Männer doppelt so häufig betroffen, über 60 Jahre ist die Mehrzahl der Patienten weiblich [19]. Dies ist bedingt durch die Dominanz der osteoporotischen Wirbelkörperfraktu-ren im höheren Lebensalter.…”