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A system of predictive scores to evaluate the risk of multilevel noncontiguous spinal fractures in patients with traumatic cervical spine injury

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Abstract

Purpose

To develop a predictive scoring system to identify traumatic cervical spine injury patients at a high risk of having multilevel noncontiguous spinal fractures.

Methods

This 12-year retrospective observational cohort study included 588 traumatic cervical spine-injured patients. Patients were categorized into two groups: patients with multilevel noncontiguous spinal fractures and patients without this remote injury. Potential risk factors were examined using multivariable analysis to derive a predictive risk score from independent predictors. Results are presented as odds ratio with a 95% confidence interval (95% CI). The accuracy of the calculated predicted score was demonstrated by the area under the receiver operating characteristic curve (AuROC).

Results

The incidence of noncontiguous fracture among the patients was 17% (100 of 588). The independent risk factors associated with multilevel noncontiguous spinal fractures were motor weakness, intracranial injury, intrathoracic injury, and intraabdominal injury. The AuROC of the prediction score was 0.74 (95% CI 0.69, 0.80). The patients were classified into three groups, low-risk group (score< 1), moderate-risk group (score 1–2.5), and high-risk group (score≥ 3), based on the predicted risk of multilevel noncontiguous spinal fractures.

Conclusions

This tool can potentially help preventing the missed diagnosis of cervical spine injuries with multilevel noncontiguous spinal fractures. CT scans or MRI of the entire spine to investigate remote multilevel noncontiguous spinal fractures may have a role in cervical spine-injured patients who have at least one of the independent risk factors and are strongly suggested for patients with scores in the high-risk group.

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Acknowledgements

The authors are grateful to G. Lamar Robert, PhD and Chongchit Robert, PhD for reviewing the manuscript

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot Road Soi 2, Si Phum, Amphoe Mueang Chiang Mai, Chiang Mai, 50200, Thailand

    Torphong Bunmaprasert, Anuchit Chaiamporn, Anupong Laohapoonrungsee, Kanlaya Chunjai & Pichitchai Atthakomol

  2. Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, 56000, Thailand

    Wongthawat Liawrungrueang

  3. Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Pichitchai Atthakomol

Authors
  1. Torphong Bunmaprasert
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Contributions

TB, AC and PA initiated study conception and design. TB, AC and PA performed the data collection and acquisition of data. TB, AC and PA performed the data analysis. TB, AC, AL, WL, KC and PA interpreted the data. TB, AC and PA wrote the original draft of the manuscript. TB, AC, AL, WL, KC and PA edited the manuscript.

Corresponding author

Correspondence to Pichitchai Atthakomol.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. The Ethics Committees in Faculty of Medicine, Chiang Mai University approved this study. Informed consent was waived due to nature of the observational study.

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Bunmaprasert, T., Chaiamporn, A., Laohapoonrungsee, A. et al. A system of predictive scores to evaluate the risk of multilevel noncontiguous spinal fractures in patients with traumatic cervical spine injury. Eur Spine J (2024). https://doi.org/10.1007/s00586-024-08277-8

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  • DOI: https://doi.org/10.1007/s00586-024-08277-8

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