Mortality After Operatively Treated Cervical Spine Fractures – A National FinSpine Register Study

Study DesignNationwide register study.ObjectiveThe incidence of cervical spine fractures and related surgeries are increasing in the ageing population, yet population-based outcome data remain limited. This study aimed to identify factors associated with mortality and to analyze causes of death following surgical treatment for cervical spine fractures in a nationwide cohort.MethodsA cohort of 979 patients undergoing surgery for cervical spine fractures (2017-2024) was identified from the nationwide FinSpine register. Independent risk factors for mortality were identified with Cox proportional hazards models. Patient data were linked with national records on mortality and causes-of-death. Standardized mortality ratios (SMRs) were calculated for comparison with the age- and sex-matched general population.ResultsThe 1-year mortality rate was 11.8%, increasing with age from 3.9% in patients younger than 65 years to 24.9% in those aged 85 years or older. Increasing age (HR 1.06 per year) and spinal cord injury (HR 1.71) predicted mortality. Compared with the general population, mortality was significantly elevated across all age groups, with highest standardized mortality ratio in patients younger than 65 years (SMR 8.3) and lowest for patients aged ≥85 years (SMR 2.0). External causes (accidents and violence) were the leading causes of death and highly over-represented (SMR 22.7) in the patients.ConclusionsIncreasing age and spinal cord injury predict mortality after surgery for cervical spine fractures. The low relative excess mortality in elderly patients, compared to the general population, supports the potential role of operative management with careful patient selection even in advanced age.