Purpose <p>This study aimed to investigate the incidence and risk factors of thoracolumbar noncontiguous spinal fractures (NSF) in surgically treated older patients with cervical spine injuries and to evaluate their association with functional outcomes.</p> Methods <p>We retrospectively reviewed 115 patients aged ≥ 65 years who underwent surgery for traumatic cervical spine injuries between 2015 and 2025. Thoracolumbar NSF were defined as fractures located at least two vertebral levels away from the cervical injury. Patient background, comorbidities, laboratory data, and imaging findings were collected. Functional outcome was assessed using the Barthel Index (BI) at discharge, with BI ≥ 60 indicating functional independence. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of NSF and BI ≥ 60.</p> Results <p>Thoracolumbar NSF were observed in 39.1% of patients. High-energy trauma (odds ratio [OR]: 70.7) and pre-existing vertebral fractures (OR: 12.8) were identified as independent positive predictors, whereas the presence of ossification of the posterior longitudinal ligament was negatively associated with NSF (OR: 0.12). In multivariate analysis for BI ≥ 60, higher serum albumin (OR: 10.7) and lower Charlson Comorbidity Index (OR: 0.46) were associated with better functional outcomes, while spinal cord injury was a negative predictor (OR: 0.17). The presence of thoracolumbar NSF was not associated with functional outcome.</p> Conclusion <p>Thoracolumbar NSF are relatively common in surgically treated older patients with cervical spine injuries. Although they were not linked to worse functional outcomes, their strong association with high-energy trauma and skeletal fragility highlights the need for comprehensive spinal imaging and early risk assessment.</p>