Original Contributions
Distribution and patterns of blunt traumatic cervical spine injury*,**,*

https://doi.org/10.1067/mem.2001.116150Get rights and content

Abstract

Study Objective: Previous studies of cervical spine injury involve individual institutions or special populations. There is currently little reliable information regarding natural cervical spine injury patterns after blunt trauma. This substudy of the National Emergency X-Radiography Utilization Study project was designed to accurately assess the prevalence, spectrum, and distribution of cervical spine injury after blunt trauma. Methods: We prospectively enrolled all patients with blunt trauma undergoing cervical spine radiography at 21 diverse institutions. Injury status was determined by review of all radiographic studies obtained on each patient. For each individual injury, we recorded which specific films revealed the injury, the level and location of injury on each vertebra, and the age and sex of the patient. Results: Of 34,069 enrolled patients with blunt trauma, 818 (2.4%) individuals had a total of 1,496 distinct cervical spine injuries to 1,285 different cervical spine structures. The second cervical vertebra was the most common level of injury (286 [24.0%] fractures, including 92 odontoid fractures), and 470 (39.3%) fractures occurred in the 2 lowest cervical vertebrae (C6 and C7). The vertebral body, injured in 235 patients, was the most frequent site of fracture. Nearly one third of all injuries (29.3%) were considered clinically insignificant. Conclusion: Cervical spine injuries occur in a small minority of patients with blunt trauma who undergo imaging. The atlantoaxial region is the most common site of injury, and the sixth and seventh vertebrae are involved in over one third of all injuries. Other spine levels are much more commonly involved than has previously been appreciated. A substantial minority of radiographically defined cervical spine injuries are of little clinical importance. [Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR, for the NEXUS Group. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med. July 2001;38:17-21.]

Introduction

Injuries to the cervical spine occur in only 2% to 3% of all patients with blunt trauma but are significant because of their high level of associated mortality and morbidity.1, 2 Previous reports regarding the epidemiology of cervical spine injury have typically been based on review of inpatient records of trauma victims admitted to single institutions or special populations.3, 4, 5, 6, 7, 8 Data from these sources typically reflect the spectrum of injuries seen in large referral centers but do not provide reliable information on the overall characteristics of cervical spine injury.

To date, there have been no reliable investigations of the spectrum and distribution of cervical spine injuries. The purpose of this study is to examine cervical spine injury patterns by using prospective representative methodology and to determine the incidence, spectrum, and distribution of these injuries.

Section snippets

Materials and methods

We performed a secondary analysis of the National Emergency X-Radiography Utilization Study (NEXUS) relational database. A detailed description of this study and its methodology are included elsewhere, including a separate report in this issue.9, 10 Briefly, NEXUS was a prospective, observational study performed with institutional review board approval at 21 diverse emergency departments in the United States. The study included all patients with blunt trauma who underwent cervical spine

Results

Of 34,069 enrolled patients, 818 (2.4%) had a radiographic cervical spine injury. These patients sustained 1,195 fractures and 231 subluxations or dislocations. The distribution of fractures is listed in Table 1.

. Distribution of fractures by cervical spine level.

Spine LevelNo. of Fractures% of All Fractures
Occipital condyle201.67
C11058.79
C2 (nonodontoid)19416.23
Odontoid927.70
C3514.27
C4847.03
C517914.98
C624220.25
C722819.08
Total1,195100.00
C2 (including the odontoid) was the most common site of

Discussion

Previous studies of cervical spine injury have been limited by the methods used to identify patients. Studies completed on the basis of chart review from a single institution,3 hospitalized patients,3, 4 or the elderly7, 11, 12, 13 all contain selection biases that limit their external validity and make it difficult to generalize results to larger populations.14 In contrast, the prospective data collected in the current study come from a diverse group of institutions and contain data on all

Acknowledgements

Author contributions: WG, CM, EAP, ST, JRH, and WRM participated in the project development, data collection, interpretation, authorship, and critical review. WG and WRM take responsibility for the paper as a whole.

We thank Guy Merchant, NEXUS Project Coordinator, for his outstanding contributions to the project, as well as the house officers and attending physicians at each of the participating NEXUS sites, without whose cooperation and hard work the study would not have been possible.

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Author contributions are provided at the end of this article.

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Supported by grant No. RO1 HS08239 from the Agency for Healthcare Research and Quality,formerly the Agency for Health Care Policy and Research.

*

Address for reprints: William L. Goldberg, MD, Department of Emergency Medicine, Bellevue Hospital Center, First Avenue at 27th Street, New York, NY 10016;,212-562-7356; E-mail [email protected].

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