The epidemiology of traumatic cervical spine fractures: a prospective population study from Norway

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Eirik Helseth¹  Pål Rønning²  Bjarne Lied³  Syed Ali Mujtaba Rizvi¹  Hege Linnerud Fredø³ 

[1] Faculty of Medicine, University of Oslo, Oslo, Norway;Department of Neurosurgery, Oslo University Hospital–Rikshospitalet, Oslo, Norway;Department of Neurosurgery, Oslo University Hospital–Ullevål, Oslo, N-0407, Norway

关键词: Epidemiology;    Incidence;    Trauma;    Spinal fractures;    Cervical vertebrae;   

Others  :  826224
DOI  :  10.1186/1757-7241-20-85

 received in 2012-08-20, accepted in 2012-12-16,  发布年份 2012

【 摘 要 】

Aim

The aim of this study was to estimate the incidence of traumatic cervical spine fractures (CS-fx) in a general population.

Background

The incidence of CS-fx in the general population is largely unknown.

Methods

All CS-fx (C0/C1 to C7/Th1) patients diagnosed with cervical-CT in Southeast Norway (2.7 million inhabitants) during the time period from April 27, 2010-April 26, 2011 were prospectively registered in this observational cohort study.

Results

Over a one-year period, 319 patients with CS-fx at one or more levels were registered, constituting an estimated incidence of 11.8/100,000/year. The median age of the patients was 56 years (range 4–101 years), and 68% were males. The relative incidence of CS-fx increased significantly with age. The trauma mechanisms were falls in 60%, motorized vehicle accidents in 21%, bicycling in 8%, diving in 4% and others in 7% of patients. Neurological status was normal in 79%, 5% had a radiculopathy, 8% had an incomplete spinal cord injury (SCI), 2% had a complete SCI, and neurological function could not be determined in 6%. The mortality rates after 1 and 3 months were 7 and 9%, respectively. Among 319 patients, 26.6% were treated with open surgery, 68.7% were treated with external immobilization with a stiff collar and 4.7% were considered stable and not in need of any specific treatment. The estimated incidence of surgically treated CS-fx in our population was 3.1/100,000/year.

Conclusions

This study estimates the incidence of traumatic CS-fx in a general Norwegian population to be 11.8/100,000/year. A male predominance was observed and the incidence increased with increasing age. Falls were the most common trauma mechanism, and SCI was observed in 10%. The 1- and 3-month mortality rates were 7 and 9%, respectively. The incidence of open surgery for the fixation of CS-fx in this population was 3.1/100,000/year.

Level of evidence

This is a prospective observational cohort study and level II-2 according to US Preventive Services Task Force.

【 授权许可】

   
2012 Fredø et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Clayton JL, Harris MB, Weintraub SL, Marr AB, Timmer J, Stuke LE, et al.: Risk factors for cervical spine injury. Injury 2012, 43:431-435.
• [2]Brown RL, Brunn MA, Garcia VF: Cervical spine injuries in children: a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 2001, 36:1107-1114.
• [3]Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN: Spinal injuries in children. J Pediatr Surg 2004, 39:607-612.
• [4]Hills MW, Deane SA: Head injury and facial injury: is there an increased risk of cervical spine injury? J Trauma 1993, 34:549-553.
• [5]Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M: Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992, 21:1454-1460.
• [6]Lowery DW, Wald MM, Browne BJ, Tigges S, Hoffman JR, Mower WR: Epidemiology of cervical spine injury victims. Ann Emerg Med 2001, 38:12-16.
• [7]Michael DB, Guyot DR, Darmody WR: Coincidence of head and cervical spine injury. J Neurotrauma 1989, 6:177-189.
• [8]Mulligan RP, Friedman JA, Mahabir RC: A nationwide review of the associations among cervical spine injuries, head injuries, and facial fractures. J Trauma 2010, 68:587-592.
• [9]O’Malley KF, Ross SE: The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma 1988, 28:1476-1478.
• [10]Roberge RJ, Wears RC, Kelly M, Evans TC, Kenny MA, Daffner RD, et al.: Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma 1988, 28:784-788.
• [11]Sanchez B, Waxman K, Jones T, Conner S, Chung R, Becerra S: Cervical spine clearance in blunt trauma: evaluation of a computed tomography-based protocol. J Trauma 2005, 59:179-183.
• [12]Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, et al.: The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001, 286:1841-1848.
• [13]Thompson WL, Stiell IG, Clement CM, Brison RJ: Association of injury mechanism with the risk of cervical spine fractures. CJEM 2009, 11:14-22.
• [14]Williams J, Jehle D, Cottington E, Shufflebarger C: Head, facial, and clavicular trauma as a predictor of cervical-spine injury. Ann Emerg Med 1992, 21:719-722.
• [15]Yanar H, Demetriades D, Hadjizacharia P, Nomoto S, Salim A, Inaba K, et al.: Pedestrians injured by automobiles: risk factors for cervical spine injuries. J Am Coll Surg 2007, 205:794-799.
• [16]Hu R, Mustard CA, Burns C: Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 1996, 21:492-499.
• [17]Schoenfeld AJ, Sielski B, Rivera KP, Bader JO, Harris MB: Epidemiology of cervical spine fractures in the US military. Spine J24-4-2012. Ref Type: Electronic Citation
• [18]Holly LT, Kelly DF, Counelis GJ, Blinman T, McArthur DL, Cryer HG: Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics. J Neurosurg 2002, 96:285-291.
• [19]Jackson AB, Dijkers M, Devivo MJ, Poczatek RB: A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil 2004, 85:1740-1748.
• [20]Kattail D, Furlan JC, Fehlings MG: Epidemiology and clinical outcomes of acute spine trauma and spinal cord injury: experience from a specialized spine trauma center in Canada in comparison with a large national registry. J Trauma 2009, 67:936-943.
• [21]McCabe JB, Angelos MG: Injury to the head and face in patients with cervical spine injury. Am J Emerg Med 1984, 2:333-335.
• [22]Bohlman HH: Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am 1979, 61:1119-1142.
• [23]Leucht P, Fischer K, Muhr G, Mueller EJ: Epidemiology of traumatic spine fractures. Injury 2009, 40:166-172.
• [24]Ryan MD, Henderson JJ: The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury 1992, 23:38-40.
• [25]Soicher E, Demetriades D: Cervical spine injuries in patients with head injuries. Br J Surg 1991, 78:1013-1014.
• [26]Steudel WI, Rosenthal D, Lorenz R, Merdes W: Prognosis and treatment of cervical spine injuries with associated head trauma. Acta Neurochir Suppl 1988, 43:85-90.
• [27]ICD-10: International statistical classification of diseases and related health problems. Geneva: World Health Organization; 2009.
• [28]Stein SC, Spettell C: The Head Injury Severity Scale (HISS): a practical classification of closed-head injury. Brain Inj 1995, 9:437-444.
• [29]Anderson LD, D’Alonzo RT: Fractures of the odontoid process of the axis. J Bone Joint Surg Am 1974, 56:1663-1674.
• [30]Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA Jr, et al.: The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine 2007, 32:2365-2374.
• [31]Bayless P, Ray VG: Incidence of cervical spine injuries in association with blunt head trauma. Am J Emerg Med 1989, 7:139-142.
• [32]Hagen EM, Eide GE, Rekand T, Gilhus NE, Gronning M: A 50-year follow-up of the incidence of traumatic spinal cord injuries in Western Norway. Spinal Cord 2010, 48:313-318.
• [33]Harris MB, Reichmann WM, Bono CM, Bouchard K, Corbett KL, Warholic N, et al.: Mortality in elderly patients after cervical spine fractures. J Bone Joint Surg Am 2010, 92:567-574.
• [34]ter Gunne AF P, Aquarius AE, Roukema JA: Risk factors predicting mortality after blunt traumatic cervical fracture. Injury 2008, 39:1437-1441.
• [35]Sokolowski MJ, Jackson AP, Haak MH, Meyer PR Jr, Szewczyk SM: Acute outcomes of cervical spine injuries in the elderly: atlantaxial vs subaxial injuries. J Spinal Cord Med 2007, 30:238-242.
• [36]Julien TD, Frankel B, Traynelis VC, Ryken TC: Evidence-based analysis of odontoid fracture management. Neurosurg Focus 8(6):e1. 24-4-2012. Ref Type: Electronic Citation
• [37]Harrop JS, Hart R, Anderson PA: Optimal treatment for odontoid fractures in the elderly. Spine 2010, 35:S219-S227.
• [38]Rizvi SA, Fredo HL, Lied B, Nakstad PH, Ronning P, Helseth E: Surgical management of acute odontoid fractures: Surgery-related complications and long-term outcomes in a consecutive series of 97 patients. J Trauma Acute Care Surg 2012, 72:682-690.
• [39]Alker GJ, Oh YS, Leslie EV, Lehotay J, Panaro VA, Eschner EG: Postmortem radiology of head neck injuries in fatal traffic accidents. Radiology 1975, 114:611-617.
• [40]Bucholz RW, Burkhead WZ, Graham W, Petty C: Occult cervical spine injuries in fatal traffic accidents. J Trauma 1979, 19:768-771.