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Cervical spine fractures in the elderly patient represent a significant clinical challenge, with mortality rates exceeding 25% at one year. As the population ages, trauma surgeons increasingly encounter these complex cases that require clinical expertise and an understanding of frailty, realistic prognostication, and early goals of care discussions.

When a patient with a pre-existing DNAR (Do Not Attempt Resuscitation) requires surgery, the goal is to respect autonomy while ensuring informed, individualized care. Some institutions automatically suspend DNAR in context of surgery. We recommend reassessing patients DNAR status prior to surgery, in a way that respects autonomy while ensuring informed, individualized care as able, within your institutional policies.