Association of injury mechanism with the risk of cervical spine fractures

Abstract

Objective:A full understanding of an injury event and the mechanical forces involved should be important for predicting specific anatomical patterns of injury. Yet, information on the mechanism of injury is often overlooked as a predictor for specific anatomical injury in clinical decision-making. We measured the relationship between mechanism of injury and risk for cervical spine fracture.Methods:Our case-control study is a secondary analysis of data collected from the Canadian C-Spine Rule (CCR) study. Data were collected from 1996 to 2002 and included patients presenting to the emergency departments of 9 tertiary care centres after sustaining acute blunt trauma to the head or neck. Cases are defined as patients who were categorized in the CCR study with a clinically important cervical spine fracture. Controls had no radiologic evidence of cervical spine injury. Bivariate and multivariate unconditional logistic regression models were used. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs).Results:Among the 17 208 patients in the CCR study, 320 (2%) received a diagnosis of a cervical spine fracture. Axial loads, falls, diving incidents and nontraffic motorized vehicle collisions (e.g., collisions involving snowmobiles or all-terrain vehicles) were injury mechanisms that were significantly related to a higher risk of fracture. For motor vehicle collisions, the risk of cervical spine injury increased with the posted speed, being involved in a head-on collision or a rollover, or not wearing a seat belt (p< 0.05). The occurrence of cervical spine fracture was negligible in simple rear-end collisions (1 in 3694 cases; OR 0.015, 95% CI 0.002–0.104]).Conclusion:Our study quantitatively demonstrates the relationship between specific mechanisms of injury and the risk of a cervical spine fracture. A full understanding of the injury mechanism would assist providers of emergency health care in assessing risk for injury in trauma patients.

Demographic and clinical characteristics of patients with traumatic cervical spinal cord injury: a Turkish hospital-based study

“…The third most common cause of CSCI was diving into shallow water, which is not surprising in consideration of Turkey's extensive shoreline. Thompson et al 18 reported that diving-related CSCI accounted for only 3.1% of all causes of injury, but that diving 14 which is lower than the 18.2% observed in the present study that was conducted between 2010 and 2013, showing an increase in the incidence of diving accident-related CSCI. This indicates to us that there is a lack of diving safety educational programming.…”

Cervical spine injuries and flexibilities following axial impact with lateral eccentricity

“…In a retrospective review, Allen et al [7] reported that 54 % of injuries to the lower cervical spine were compression-type (with and without associated flexion/extension). This is consistent with the previously reported observation that axial compression, which would be present during a headfirst impact, is associated with an increased risk of injury to the cervical spine [8]. Only 3 % of the injuries reported by Allen et al [7] were due to lateral bending and these relatively uncommon injuries are well-recognized in clinical practice [3,4,9,10].…”

Acoustic emission signals can discriminate between compressive bone fractures and tensile ligament injuries in the spine during dynamic loading

“…In the in vivo spine, ligaments are thought to fail due to local tension resulting from spine distraction or rotation while most injuries to vertebral bodies are thought to result from compression forces (McElhaney et al, 1979;Allen et al, 1982;Yoganandan et al, 1989;White and Panjabi, 1990;Torg et al, 2002;Moffatt et al, 2003;Thompson et al, 2009). AE signals have been reported for slow compression loading of human cadaver vertebral bodies (Hasegawa et al, 1993a;1993b); however this may not be representative of most in vivo failure modes as AE signals produced by bone are a function of loading rate (Wells and Rawlings, 1985;Fischer et al, 1986), and most spinal injuries in vivo occur as a result of blunt impact (Thompson et al, 2009).…”