{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T15:24:29Z","timestamp":1794324269568,"version":"4.9.0"},"reference-count":88,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2015,10]]},"abstract":"\n OBJECT<\/jats:title>\n Traumatic fractures of the thoracolumbar spine are common injuries, accounting for approximately 90% of all spinal trauma. Lumbar spine trauma in the elderly is a growing public health problem with relatively little evidence to guide clinical management. The authors sought to characterize the complications, morbidity, and mortality associated with surgical and nonsurgical management in elderly patients with traumatic fractures of the lumbar spine.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Using the National Sample Program of the National Trauma Data Bank, the authors performed a retrospective analysis of patients \u2265 55 years of age who had traumatic fracture to the lumbar spine. This group was divided into middle-aged (55\u201369 years) and elderly (\u2265 70 years) cohorts. Cohorts were subdivided into nonoperative, vertebroplasty or kyphoplasty, noninstrumented surgery, and instrumented surgery. Univariate and multivariable analyses were used to characterize and identify predictors of medical and surgical complications, mortality, hospital length of stay, ICU length of stay, number of days on ventilator, and hospital discharge in each subgroup. Adjusted odds ratios, mean differences, and associated 95% CIs were reported. Statistical significance was assessed at p < 0.05, and the Bonferroni correction for multiple comparisons was applied for each outcome analysis.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Between 2003 and 2012, 22,835 people met the inclusion criteria, which represents 94,103 incidents nationally. Analyses revealed a similar medical and surgical complication profile between age groups. The most prevalent medical complications were pneumonia (7.0%), acute respiratory distress syndrome (3.6%), and deep venous thrombosis (3%). Surgical site infections occurred in 6.3% of cases. Instrumented surgery was associated with the highest odds of each complication (p < 0.001). The inpatient mortality rate was 6.8% for all subjects. Multivariable analyses demonstrated that age \u2265 70 years was an independent predictor of mortality (OR 3.16, 95% CI 2.77\u20133.60), whereas instrumented surgery (multivariable OR 0.38, 95% CI 0.28\u20130.52) and vertebroplasty or kyphoplasty (OR 0.27, 95% CI 0.17\u20130.45) were associated with decreased odds of death. In surviving patients, both older age (OR 0.32, 95% CI 0.30\u20130.34) and instrumented fusion (OR 0.37, 95% CI 0.33\u20130.41) were associated with decreased odds of discharge to home.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The present study confirms that lumbar surgery in the elderly is associated with increased morbidity. In particular, instrumented fusion is associated with periprocedural complications, prolonged hospitalization, and a decreased likelihood of being discharged home. However, fusion surgery is also associated with reduced mortality. Age alone should not be an exclusionary factor in identifying surgical candidates for instrumented lumbar spinal fusion. Future studies are needed to confirm these findings.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2015.7.focus15270","type":"journal-article","created":{"date-parts":[[2015,10,1]],"date-time":"2015-10-01T03:41:45Z","timestamp":1443670905000},"page":"E2","source":"Crossref","is-referenced-by-count":30,"title":["Perioperative morbidity and mortality after lumbar trauma in the elderly"],"prefix":"10.3171","volume":"39","author":[{"given":"Ethan A.","family":"Winkler","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K.","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harjus","family":"Birk","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin K.","family":"Robinson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey T.","family":"Manley","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay S.","family":"Dhall","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phiroz E.","family":"Tarapore","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco; and Brain and Spinal Injury Center, San Francisco General Hospital, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1-focus15270","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management","volume":"37","author":"Bakhsheshian","year":"2014"},{"issue":"9 Suppl","key":"b2-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"S138","article-title":"Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality?","volume":"35","author":"Bellabarba","year":"2010"},{"key":"b3-focus15270","series-title":"J Trauma","first-page":"855","article-title":"Incidence, epidemiology, and occupational outcomes of thoracolumbar fractures among U.S. Army aviators","volume":"50","author":"Belmont","year":"2001"},{"key":"b4-focus15270","series-title":"Calcif Tissue Int","first-page":"293","article-title":"Changes in incidence and prevalence of vertebral fractures during 30 years","volume":"42","author":"Bengn\u00e9r","year":"1988"},{"key":"b5-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"1475","article-title":"Risk factors for surgical site infection in the patient with spinal injury","volume":"28","author":"Blam","year":"2003"},{"key":"b6-focus15270","series-title":"N Engl J Med","first-page":"557","article-title":"A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures","volume":"361","author":"Buchbinder","year":"2009"},{"issue":"1","key":"b7-focus15270","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Bracing for thoracolumbar fractures","volume":"37","author":"Chang","year":"2014"},{"key":"b8-focus15270","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b9-focus15270","series-title":"J Bone Joint Surg Am","first-page":"1729","article-title":"Impact of nonoperative treatment, vertebroplasty, and kyphoplasty on survival and morbidity after vertebral compression fracture in the Medicare population","volume":"95","author":"Chen","year":"2013"},{"key":"b10-focus15270","series-title":"Neurol Res","first-page":"617","article-title":"A nationwide epidemiological study of spinal cord injuries in Taiwan from July 1992 to June 1996","volume":"19","author":"Chen","year":"1997"},{"key":"b11-focus15270","series-title":"Curr Osteoporos Rep","first-page":"198","article-title":"Biomechanics of vertebral fractures and the vertebral fracture cascade","volume":"8","author":"Christiansen","year":"2010"},{"key":"b12-focus15270","series-title":"J Bone Miner Res","first-page":"221","article-title":"Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985\u20131989","volume":"7","author":"Cooper","year":"1992"},{"key":"b13-focus15270","series-title":"Ann Surg","first-page":"851","article-title":"Does optimal timing for spine fracture fixation exist?","volume":"233","author":"Croce","year":"2001"},{"key":"b14-focus15270","series-title":"Injury","first-page":"195","article-title":"Acute central cervical cord injury: the effect of age upon prognosis","volume":"32","author":"Dai","year":"2001"},{"key":"b15-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"817","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"issue":"1","key":"b16-focus15270","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Traumatic thoracolumbar spinal injury: an algorithm for minimally invasive surgical management","volume":"37","author":"Dhall","year":"2014"},{"key":"b17-focus15270","series-title":"J Bone Miner Res","first-page":"1617","article-title":"Mortality risk for operated and nonoperated vertebral fracture patients in the Medicare population","volume":"26","author":"Edidin","year":"2011"},{"key":"b18-focus15270","series-title":"BMJ","first-page":"f6234","article-title":"The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials","volume":"347","author":"El-Khoury","year":"2013"},{"key":"b19-focus15270","series-title":"PLoS One","first-page":"e0117122","article-title":"Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws","volume":"10","author":"Eschler","year":"2015"},{"key":"b20-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"2201","article-title":"Natural history and risk factors for adjacent vertebral fractures in the fracture intervention trial","volume":"38","author":"Frankel","year":"2013"},{"issue":"Suppl 3","key":"b21-focus15270","series-title":"Eur Spine J","first-page":"S324","article-title":"Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility","volume":"23","author":"Galbusera","year":"2014"},{"issue":"4","key":"b22-focus15270","series-title":"Cochrane Database Syst Rev","first-page":"CD000340","article-title":"Interventions for preventing falls in elderly people","author":"Gillespie","year":"2003"},{"key":"b23-focus15270","series-title":"Eur J Epidemiol","first-page":"431","article-title":"Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital","volume":"25","author":"Jansson","year":"2010"},{"key":"b24-focus15270","series-title":"Osteoporos Int","first-page":"669","article-title":"Long-term risk of osteoporotic fracture in Malm\u00f6","volume":"11","author":"Kanis","year":"2000"},{"key":"b25-focus15270","series-title":"Arch Intern Med","first-page":"2145","article-title":"Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons","volume":"160","author":"Kannus","year":"2000"},{"key":"b26-focus15270","series-title":"J Trauma","first-page":"1308","article-title":"The effect of early surgical treatment of traumatic spine injuries on patient mortality","volume":"63","author":"Kerwin","year":"2007"},{"key":"b27-focus15270","series-title":"J Trauma","first-page":"15","article-title":"The effect of early spine fixation on nonneurologic outcome","volume":"58","author":"Kerwin","year":"2005"},{"key":"b28-focus15270","series-title":"J Trauma","first-page":"824","article-title":"Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank","volume":"65","author":"Kerwin","year":"2008"},{"key":"b29-focus15270","series-title":"J Orthop Trauma","first-page":"541","article-title":"Functional outcome of thoracolumbar burst fractures without neurological deficit","volume":"10","author":"Kraemer","year":"1996"},{"key":"b30-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"1631","article-title":"Initial outcome and efficacy of \u201ckyphoplasty\u201d in the treatment of painful osteoporotic vertebral compression fractures","volume":"26","author":"Lieberman","year":"2001"},{"key":"b31-focus15270","series-title":"Clin Orthop Relat Res","first-page":"114","article-title":"Surgical infections in the traumatized spine","volume":"444","author":"Lim","year":"2006"},{"key":"b32-focus15270","series-title":"Arch Phys Med Rehabil","first-page":"1402","article-title":"Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis","volume":"80","author":"McKinley","year":"1999"},{"key":"b33-focus15270","series-title":"J Neurosurg Spine","first-page":"469","article-title":"Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support","volume":"17","author":"Murata","year":"2012"},{"key":"b34-focus15270","series-title":"J Bone Miner Res","first-page":"1207","article-title":"Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study","volume":"21","author":"Samelson","year":"2006"},{"key":"b35-focus15270","series-title":"Spine (Phila Pa 1976)","article-title":"Analysis of delays to surgery for cervical spinal cord injuries","author":"Samuel","year":"2015"},{"key":"b36-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"349","article-title":"Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality","volume":"40","author":"Samuel","year":"2015"},{"key":"b37-focus15270","series-title":"Spine J","first-page":"1766","article-title":"Patient demographics, insurance status, race, and ethnicity as predictors of morbidity and mortality after spine trauma: a study using the National Trauma Data Bank","volume":"13","author":"Schoenfeld","year":"2013"},{"key":"b38-focus15270","series-title":"N Engl J Med","first-page":"1055","article-title":"Prevention of falls among the elderly","volume":"320","author":"Tinetti","year":"1989"},{"key":"b39-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"2325","article-title":"A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status","volume":"30","author":"Vaccaro","year":"2005"},{"key":"b40-focus15270","series-title":"J Bone Miner Res","first-page":"1051","article-title":"The incidence of vertebral fractures in men and women: the Rotterdam Study","volume":"17","author":"Van der Klift","year":"2002"},{"key":"b41-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"803","article-title":"Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome","volume":"29","author":"Verlaan","year":"2004"},{"key":"b42-focus15270","series-title":"Injury","first-page":"2109","article-title":"Epidemiology of spinal fractures among the elderly in Chongqing, China","volume":"43","author":"Wang","year":"2012"},{"issue":"4","key":"b43-focus15270","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Osteoporotic vertebral fractures","volume":"10","author":"Watts","year":"2001"},{"key":"b44-focus15270","series-title":"Geriatr Orthop Surg Rehabil","first-page":"43","article-title":"Thoracolumbar spine fractures in the geriatric fracture center: early ambulation leads to good results on short term and is a successful and safe alternative compared to immobilization in elderly patients with two-column vertebral fractures","volume":"5","author":"Weerink","year":"2014"},{"issue":"1","key":"b1-focus15270","series-title":"Neurosurg Focus","first-page":"E1","article-title":"Evidence-based management of traumatic thoracolumbar burst fractures: a systematic review of nonoperative management","volume":"37","author":"Bakhsheshian","year":"2014"},{"issue":"9 Suppl","key":"b2-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"S138","article-title":"Does early fracture fixation of thoracolumbar spine fractures decrease morbidity or mortality?","volume":"35","author":"Bellabarba","year":"2010"},{"key":"b3-focus15270","series-title":"J Trauma","first-page":"855","article-title":"Incidence, epidemiology, and occupational outcomes of thoracolumbar fractures among U.S. Army aviators","volume":"50","author":"Belmont","year":"2001"},{"key":"b4-focus15270","series-title":"Calcif Tissue Int","first-page":"293","article-title":"Changes in incidence and prevalence of vertebral fractures during 30 years","volume":"42","author":"Bengn\u00e9r","year":"1988"},{"key":"b5-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"1475","article-title":"Risk factors for surgical site infection in the patient with spinal injury","volume":"28","author":"Blam","year":"2003"},{"key":"b6-focus15270","series-title":"N Engl J Med","first-page":"557","article-title":"A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures","volume":"361","author":"Buchbinder","year":"2009"},{"issue":"1","key":"b7-focus15270","series-title":"Neurosurg Focus","first-page":"E3","article-title":"Bracing for thoracolumbar fractures","volume":"37","author":"Chang","year":"2014"},{"key":"b8-focus15270","series-title":"J Chronic Dis","first-page":"373","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987"},{"key":"b9-focus15270","series-title":"J Bone Joint Surg Am","first-page":"1729","article-title":"Impact of nonoperative treatment, vertebroplasty, and kyphoplasty on survival and morbidity after vertebral compression fracture in the Medicare population","volume":"95","author":"Chen","year":"2013"},{"key":"b10-focus15270","series-title":"Neurol Res","first-page":"617","article-title":"A nationwide epidemiological study of spinal cord injuries in Taiwan from July 1992 to June 1996","volume":"19","author":"Chen","year":"1997"},{"key":"b11-focus15270","series-title":"Curr Osteoporos Rep","first-page":"198","article-title":"Biomechanics of vertebral fractures and the vertebral fracture cascade","volume":"8","author":"Christiansen","year":"2010"},{"key":"b12-focus15270","series-title":"J Bone Miner Res","first-page":"221","article-title":"Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985\u20131989","volume":"7","author":"Cooper","year":"1992"},{"key":"b13-focus15270","series-title":"Ann Surg","first-page":"851","article-title":"Does optimal timing for spine fracture fixation exist?","volume":"233","author":"Croce","year":"2001"},{"key":"b14-focus15270","series-title":"Injury","first-page":"195","article-title":"Acute central cervical cord injury: the effect of age upon prognosis","volume":"32","author":"Dai","year":"2001"},{"key":"b15-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"817","article-title":"The three column spine and its significance in the classification of acute thoracolumbar spinal injuries","volume":"8","author":"Denis","year":"1983"},{"issue":"1","key":"b16-focus15270","series-title":"Neurosurg Focus","first-page":"E9","article-title":"Traumatic thoracolumbar spinal injury: an algorithm for minimally invasive surgical management","volume":"37","author":"Dhall","year":"2014"},{"key":"b17-focus15270","series-title":"J Bone Miner Res","first-page":"1617","article-title":"Mortality risk for operated and nonoperated vertebral fracture patients in the Medicare population","volume":"26","author":"Edidin","year":"2011"},{"key":"b18-focus15270","series-title":"BMJ","first-page":"f6234","article-title":"The effect of fall prevention exercise programmes on fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials","volume":"347","author":"El-Khoury","year":"2013"},{"key":"b19-focus15270","series-title":"PLoS One","first-page":"e0117122","article-title":"Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws","volume":"10","author":"Eschler","year":"2015"},{"key":"b20-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"2201","article-title":"Natural history and risk factors for adjacent vertebral fractures in the fracture intervention trial","volume":"38","author":"Frankel","year":"2013"},{"issue":"Suppl 3","key":"b21-focus15270","series-title":"Eur Spine J","first-page":"S324","article-title":"Ageing and degenerative changes of the intervertebral disc and their impact on spinal flexibility","volume":"23","author":"Galbusera","year":"2014"},{"issue":"4","key":"b22-focus15270","series-title":"Cochrane Database Syst Rev","first-page":"CD000340","article-title":"Interventions for preventing falls in elderly people","author":"Gillespie","year":"2003"},{"key":"b23-focus15270","series-title":"Eur J Epidemiol","first-page":"431","article-title":"Thoracolumbar vertebral fractures in Sweden: an analysis of 13,496 patients admitted to hospital","volume":"25","author":"Jansson","year":"2010"},{"key":"b24-focus15270","series-title":"Osteoporos Int","first-page":"669","article-title":"Long-term risk of osteoporotic fracture in Malm\u00f6","volume":"11","author":"Kanis","year":"2000"},{"key":"b25-focus15270","series-title":"Arch Intern Med","first-page":"2145","article-title":"Continuously increasing number and incidence of fall-induced, fracture-associated, spinal cord injuries in elderly persons","volume":"160","author":"Kannus","year":"2000"},{"key":"b26-focus15270","series-title":"J Trauma","first-page":"1308","article-title":"The effect of early surgical treatment of traumatic spine injuries on patient mortality","volume":"63","author":"Kerwin","year":"2007"},{"key":"b27-focus15270","series-title":"J Trauma","first-page":"15","article-title":"The effect of early spine fixation on nonneurologic outcome","volume":"58","author":"Kerwin","year":"2005"},{"key":"b28-focus15270","series-title":"J Trauma","first-page":"824","article-title":"Best practice determination of timing of spinal fracture fixation as defined by analysis of the National Trauma Data Bank","volume":"65","author":"Kerwin","year":"2008"},{"key":"b29-focus15270","series-title":"J Orthop Trauma","first-page":"541","article-title":"Functional outcome of thoracolumbar burst fractures without neurological deficit","volume":"10","author":"Kraemer","year":"1996"},{"key":"b30-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"1631","article-title":"Initial outcome and efficacy of \u201ckyphoplasty\u201d in the treatment of painful osteoporotic vertebral compression fractures","volume":"26","author":"Lieberman","year":"2001"},{"key":"b31-focus15270","series-title":"Clin Orthop Relat Res","first-page":"114","article-title":"Surgical infections in the traumatized spine","volume":"444","author":"Lim","year":"2006"},{"key":"b32-focus15270","series-title":"Arch Phys Med Rehabil","first-page":"1402","article-title":"Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis","volume":"80","author":"McKinley","year":"1999"},{"key":"b33-focus15270","series-title":"J Neurosurg Spine","first-page":"469","article-title":"Union rates and prognostic variables of osteoporotic vertebral fractures treated with a rigid external support","volume":"17","author":"Murata","year":"2012"},{"key":"b34-focus15270","series-title":"J Bone Miner Res","first-page":"1207","article-title":"Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study","volume":"21","author":"Samelson","year":"2006"},{"key":"b35-focus15270","series-title":"Spine (Phila Pa 1976)","article-title":"Analysis of delays to surgery for cervical spinal cord injuries","author":"Samuel","year":"2015"},{"key":"b36-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"349","article-title":"Delayed surgery after acute traumatic central cord syndrome is associated with reduced mortality","volume":"40","author":"Samuel","year":"2015"},{"key":"b37-focus15270","series-title":"Spine J","first-page":"1766","article-title":"Patient demographics, insurance status, race, and ethnicity as predictors of morbidity and mortality after spine trauma: a study using the National Trauma Data Bank","volume":"13","author":"Schoenfeld","year":"2013"},{"key":"b38-focus15270","series-title":"N Engl J Med","first-page":"1055","article-title":"Prevention of falls among the elderly","volume":"320","author":"Tinetti","year":"1989"},{"key":"b39-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"2325","article-title":"A new classification of thoracolumbar injuries: the importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status","volume":"30","author":"Vaccaro","year":"2005"},{"key":"b40-focus15270","series-title":"J Bone Miner Res","first-page":"1051","article-title":"The incidence of vertebral fractures in men and women: the Rotterdam Study","volume":"17","author":"Van der Klift","year":"2002"},{"key":"b41-focus15270","series-title":"Spine (Phila Pa 1976)","first-page":"803","article-title":"Surgical treatment of traumatic fractures of the thoracic and lumbar spine: a systematic review of the literature on techniques, complications, and outcome","volume":"29","author":"Verlaan","year":"2004"},{"key":"b42-focus15270","series-title":"Injury","first-page":"2109","article-title":"Epidemiology of spinal fractures among the elderly in Chongqing, China","volume":"43","author":"Wang","year":"2012"},{"issue":"4","key":"b43-focus15270","series-title":"Neurosurg Focus","first-page":"E12","article-title":"Osteoporotic vertebral fractures","volume":"10","author":"Watts","year":"2001"},{"key":"b44-focus15270","series-title":"Geriatr Orthop Surg Rehabil","first-page":"43","article-title":"Thoracolumbar spine fractures in the geriatric fracture center: early ambulation leads to good results on short term and is a successful and safe alternative compared to immobilization in elderly patients with two-column vertebral fractures","volume":"5","author":"Weerink","year":"2014"}],"container-title":["Neurosurgical 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