Epidemiology Acute cervical trauma

Epidemiology Acute cervical trauma

Acute cervical trauma   
Incidence: The incidence of cervical spine injury in the setting of head injury has been reported to range between 1.8-9%4,7-9,14,15,18,25.Hu et al. reported the incidence in 1996 of spine fractures, all sites, to be 64/100,00016. However, subgrouping into cervical, thoracic or lumbar fractures was performed for only 45% of the patiënts. The assumed incidence of CS-fx can be estimated to be 12/100,000 based on this study, which was performed on a population in Canada.
Prevalence 71% of all C-spine injury patients were male, 22% were elderly (aged 65+years), 54% were injured in a transport crash, 33% were injured in a fall, 20% received in-hospital rehabilitation post-acute care (increasing to 58% for cord injuries) and 6% died during their acute hospital admission.2
Sex: Cervical spine fractures are more common in males than females1-4,6,10,11,13,17-21,26
Age: With respect to age, the highest incidence rate is reported to be among patients aged 15-45 years, with a second peak in those aged 65-80 years1-4,6-17,21-24.Median age 47.2 years (interquartile range, 29.8-66.0)26

age ≥35 years are at increased risk26

History of injury: Cervical spine injuries result primarily from motor vehicle accidents, falls, sports activities (e.g., rugby, American football, trampolining), and diving into shallow water. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism. Contrary to common belief, head injury was not predictive for cervical spine involvement.26
  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.
  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. Thompson WL, Stiell IG, Clement CM, Brison RJ: Association of injury mechanism with the risk of cervical spine fractures. CJEM 2009, 11:14-22
  13. 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.
  14. 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
  15. Hu R, Mustard CA, Burns C: Epidemiology of incident spinal fracture in a complete population. Spine (Phila Pa 1976) 1996, 21:492-499.
  16. Schoenfeld AJ, Sielski B, Rivera KP, Bader JO, Harris MB: Epidemiology of cervical spine fractures in the US military. Spine J 24-4-2012.
  17. 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.
  18. 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.
  19. 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.
  20. McCabe JB, Angelos MG: Injury to the head and face in patients with cervical spine injury. Am J Emerg Med 1984, 2:333-335.
  21. 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.
  22. Leucht P, Fischer K, Muhr G, Mueller EJ: Epidemiology of traumatic spine fractures. Injury 2009, 40:166-172.
  23. Ryan MD, Henderson JJ: The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury 1992, 23:38-40.
  24. Soicher E, Demetriades D: Cervical spine injuries in patients with head injuries.  Br J Surg 1991, 78:1013-1014.
  25. Epidemiology and predictors of cervical spine injury in adult major trauma patients: A multicenter cohort study: Hasler, Rebecca M. MD; Exadaktylos, Aristomenis K. MD; Bouamra, Omar MSc, PhD; Benneker, Lorin M. MD; Clancy, Mike MD; Sieber, Robert MD; Zimmermann, Heinz MD; Lecky, Fiona MD, PhD
  26. Epidemiology and predictors of cervical spine injury in adult major trauma patients: A multicenter cohort study: Hasler, Rebecca M. MD; Exadaktylos, Aristomenis K. MD; Bouamra, Omar MSc, PhD; Benneker, Lorin M. MD; Clancy, Mike MD; Sieber, Robert MD; Zimmermann, Heinz MD; Lecky, Fiona MD, PhD


Physical Examination

Canadian C-Spine Rules
  1. Patiënt is cognitively intact and has no neurological symptoms.
  2. Patiënt is younger than 65 years.
  3. Patiënt is not afraid to share his or her head to move on command.
  4. Patiënt had no distraction-related accident.
  5. Patiënt with no local pain don’t need a radiography
    If a positive finding in any of the 5 points is there an indication for radiography.
The function of the spinal segments related to cervical spine
Physical Examination Physical presentation
Cervical Cervical (neck) injuries usually result in full or partial tetraplegia (Quadriplegia). However, depending on the specific location and severity of trauma, limited function may be retained.Injuries at the C-1/C-2 levels will often result in loss of breathing, necessitating mechanical ventilators or phrenic nerve pacing.
C3 vertebrae and above  Typically results in loss of diaphragm function, necessitating the use of a ventilator for breathing.
C4 Results in significant loss of function at the biceps and shoulders.
C5 Results in potential loss of function at the shoulders and biceps, and complete loss of function at the wrists and hands.
C6 Results in limited wrist control, and complete loss of hand function.
C7 and T1  Results in lack of dexterity in the hands and fingers, but allows for limited use of arms.


Canadian C-Spine Rules Utility 1
Study (instab/dysf.) Sensitivity (Show) Specificity (exclude) QUADAS Score 0-14
Stiell et al.1 99 45 12
Bandiera et al.2 100 43 9
Comment: Since the test is designed as a screening test, the sensitivity is very high. The test is negative if only all 5 points are negative. The rules are designed for patiënts in the acute phase.
  1. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-2518
  2. Bandiera G, Stiell IG, Wells GA, Clement C, De Maio V, Vandemheen KL, Greenberg GH, Lesiuk H, Brison R, Cass D, Dreyer J, Eisenhauer MA, Macphail I, McKnight RD, Morrison L, Reardon M, Schull M, Worthington J; Canadian C-Spine and CT Head Study Group. The Canadian C-spine rule performs better than unstructured physician judgement. Ann Emerg Med. 2003;43(3):395-402


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