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Head injuries and the risk of concurrent cervical spine fractures

  • Original Article - Brain Injury
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

An Erratum to this article was published on 23 March 2017

Abstract

Background

Cervical spine injuries of variable severity are common among patients with an acute traumatic brain injury (TBI). We hypothesised that TBI patients with positive head computed tomography (CT) scans would have a significantly higher risk of having an associated cervical spine fracture compared to patients with negative head CT scans.

Method

This widely generalisable retrospective sample was derived from 3,023 consecutive patients, who, due to an acute head injury (HI), underwent head CT at the Emergency Department of Tampere University Hospital (August 2010–July 2012). Medical records were reviewed to identify the individuals whose cervical spine was CT-imaged within 1 week after primary head CT due to a clinical suspicion of a cervical spine injury (CSI) (n = 1,091).

Results

Of the whole cranio-cervically CT-imaged sample (n = 1,091), 24.7% (n = 269) had an acute CT-positive TBI. Car accidents 22.4% (n = 244) and falls 47.8% (n = 521) were the most frequent injury mechanisms. On cervical CT, any type of fracture was found in 6.6% (n = 72) and dislocation and/or subluxation in 2.8% (n = 31) of the patients. The patients with acute traumatic intracranial lesions had significantly (p = 0.04; OR = 1.689) more cervical spine fractures (9.3%, n = 25) compared to head CT-negative patients (5.7%, n = 47). On an individual cervical column level, head CT positivity was especially related to C6 fractures (p = 0.031, OR = 2.769). Patients with cervical spine fractures (n = 72) had altogether 101 fractured vertebrae, which were most often C2 (22.8, n = 23), C7 (19.8%, n = 20) and C6 (16.8%, n = 17).

Conclusions

Head trauma patients with acute intracranial lesions on CT have a higher risk for cervical spine fractures in comparison to patients with a CT-negative head injury. Although statistically significant, the difference in fracture rate was small. However, based on these results, we suggest that cervical spine fractures should be acknowledged when treating CT-positive TBIs.

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Acknowledgements

The authors wish to thank nurse Anne Simi for her assistance in data collection.

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Authors and Affiliations

  1. Department of Neuroscience and Rehabilitation, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland

    Tuomo Thesleff, Juha Öhman & Teemu M. Luoto

  2. Medical Imaging Centre, Department of Radiology, Tampere University Hospital, P.O. Box 2000, FI-33521, Tampere, Finland

    Anneli Kataja

Authors
  1. Tuomo Thesleff
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  2. Anneli Kataja
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  4. Teemu M. Luoto
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Correspondence to Tuomo Thesleff.

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All authors certify that they have no affiliations with or involvement in any organisation or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Comments

Analysing a large 2-year emergency room cohort retrospectively, the authors demonstrate that head injured patients with intracranial lesions on CT harbour an 1.7-fold increased risk of cervical fractures in comparison to CT-negative patients. The conclusion that cervical fractures should be acknowledged when treating CT-positive TBIs can obviously be supported and is kept in mind intuitively in general practice already. The study provides further proof for this concept. However, the risk difference of 9.3% versus 5.7% is too small to make a real difference in the ER. The c-spine clearance rules still have to be applied. Surprisingly, the rate of spinal cord injury was higher in the CT-negative cohort (1.5% vs 0.4%, i.e. 12 patients versus one single patient). It could be speculated that this may be due to central cord syndromes after minor falls in the elderly and is an interesting finding.

Claudius Thome

Tirol, Austria

An erratum to this article is available at http://dx.doi.org/10.1007/s00701-017-3156-6.

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Thesleff, T., Kataja, A., Öhman, J. et al. Head injuries and the risk of concurrent cervical spine fractures. Acta Neurochir 159, 907–914 (2017). https://doi.org/10.1007/s00701-017-3133-0

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  • DOI: https://doi.org/10.1007/s00701-017-3133-0

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