EARLY POST-ACUTE CLINICAL PARTICULARITIES OF ELDERLY WITH CERVICAL SPINAL CORD INJURY

Introduction: Evaluation of early post acute evolution after cervical spinal cord injury (CSCI) at elderly (≥65 years), first time admitted in NeuroRehabilitation, during 2004-2013.Materials and Methods: Retrospective analysis of medical files.There were 281 subjects, 201 males, 80 females (ratio 2.5); the average age was 71.5 years (range 65-86). Most of the patients (79%) were from rural regions; 56% of the CSCI happened during agricultural activity. Etiology was dominated (79 %) by accidental falls [same level (22.8%) or height (falls from chariot 41.3%, trees 5.7%, ladder 9.2%)]; traffic accidents in 21%.Results:  The evolutive trends during rehabilitation phase, pointed a seminificatively neurological improvement (p< 0.01) towards the incomplete lesional status (AIS C+D group at admission 59.4% vs.discharge 75% cases) compared to the totally paralised group (AIS A+B at admission 40.5% vs. discharge 25% cases). Comparing the evolutive direction (amelioration vs. agravation or stationary status) a significant  improvement  (p< 0.01) was noticed at the surgicaly approached group (68.6% patients) vs. conservative treatment ones (31.4%). Most of the survivors 170 (63.9%) were discharged at home, whereas 51(18.6%) were admitted in nursing home, aspects significantly correlated ( p<0.01) with the marital status vs. single (widow or divorced). Miscellaneous medical complications were acquired: transient postural hypotension (68.3%), asymptomatic urinary infections (89%), haematuria (14.4%), bronchopneumonia (11.3%), enterocolitis  (13%), deep-vein thrombosis (5.6%), mild decubitus ulcer (2.5%); depression (58.7%), central pain (44%). Mortality rate during hospitalization was 2.5%.Conclusions:  Early post-acute admision after spinal surgical stabilization and comprehensive rehabilitative approach, favored a better outcome and a low mortality rate of elderly CSCI.  Key words: cervical spinal cord injury (CSCI), elderly, etiology, early post acute evolution, comprehensive rehabilitation, outcome, medical complications, mortality rate.