Age-stratified mortality following operative management of complete versus incomplete traumatic subaxial cervical spinal cord injury

Context/Objective Postoperative mortality following traumatic subaxial cervical spinal cord injury (cSCI) remains substantial, yet the combined influence of neurologic completeness and age on survival is poorly characterized in operatively treated patients. This study evaluated age-stratified mortality after surgical management of complete versus incomplete traumatic subaxial cSCI.Design Retrospective cohort study using risk ratio analysis, Kaplan-Meier survival analysis, and multivariable Cox proportional hazards.Setting Global federated electronic health record database (TriNetX).Participants Adults who underwent surgery for traumatic subaxial cSCI, identified using ICD-10 and CPT codes, with injury classified as complete or incomplete (n = 5,477).Interventions Operative management of traumatic subaxial cSCI.Outcome Measures All-cause mortality at 3, 6 months, and 1 year postoperatively. Independent predictors of mortality were identified via Cox regression.Results Complete cSCI was associated with significantly higher mortality at 3 months (10.73% vs. 7.7%; RR 1.39), 6 months (12.5% vs. 9.2%; RR 1.36), and 1 year (14.7% vs. 11.2%; RR 1.31) (all P < 0.001). Mortality differences were most pronounced in patients aged 61–80 years, with approximately twofold higher risk in complete injuries. Increasing age, male sex, diabetes, heart failure, and chronic kidney disease independently predicted mortality.Conclusion Complete traumatic cSCI carries significantly higher postoperative mortality than incomplete injury, particularly among patients aged 61–80 years. These findings underscore the combined prognostic impact of neurologic severity and age, and may guide perioperative counseling and risk stratification, but should not be interpreted as demonstrating formal age-dependent effect modification.