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Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score

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Abstract

Purpose

This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma.

Methods

We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries.

Results

We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%).

The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004).

Conclusions

Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.

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Abbreviations

AI:

Associated injuries

AIS:

Abbreviated injury scale

CFI score:

Comprehensive facial injury score

GCS:

Glasgow Coma Scale

HDU:

High-dependency unit

ICU:

Intensive care unit

ISS:

Injury severity score

LOS:

Length of stay

MOI:

Mechanism of injury

OM:

Overall mortality

OR:

Odds ratio

OST:

Overall surgical time

SD:

Standard deviation

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Authors and Affiliations

  1. Maxillofacial Surgery Unit, Department of Neuroscience - Head & Neck, ASST GOM Niguarda, Milan, Italy

    G. Canzi

  2. Medical Physics Department, Foundation IRCCS San Gerardo Hospital, 20900, Monza, Italy

    E. De Ponti

  3. Acute Care Surgery and Trauma, ASST GOM Niguarda, Milan, Italy

    A. Spota, S. P. B. Cioffi, M. Altomare, R. Bini, F. Virdis, S. Cimbanassi & O. Chiara

  4. Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy

    A. Spota

  5. School of Medicine, University of Milano Bicocca, Milan, Italy

    G. Mangini

  6. Postgraduate School of Maxillo‐Facial Surgery, University of Milan, Milan, Italy

    E. De Simone

  7. Department of Surgical Sciences, University of Rome Sapienza, Rome, Italy

    S. P. B. Cioffi & M. Altomare

  8. Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy

    S. Cimbanassi & O. Chiara

  9. Chirurgia Maxillo Facciale, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, Monza, Italy

    D. Sozzi & G. Novelli

  10. Dipartimento di Medicina e Chirurgia, School of Medicine, Università Degli Studi di Milano-Bicocca, Milan, Italy

    D. Sozzi & G. Novelli

Authors
  1. G. Canzi
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  2. E. De Ponti
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  3. A. Spota
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  4. G. Mangini
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  7. M. Altomare
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  8. R. Bini
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  10. S. Cimbanassi
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  11. O. Chiara
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  12. D. Sozzi
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  13. G. Novelli
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Corresponding author

Correspondence to A. Spota.

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Conflict of interest

G.Canzi, E.De Ponti, A.Spota, G.Mangini, E.De Simone, S.P.B.Cioffi, M.Altomare, R.Bini, F.Virdis, S.Cimbanassi, O.Chiara, D.Sozzi, and G.Novelli declare that they have no conflict of interest.

Ethical approval

Our trauma registry has been approved by the Ethical Committee Milano Area 3 (record no. 534–102018). Given the retrospective nature of this study, specific board approval was not required. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Canzi, G., De Ponti, E., Spota, A. et al. Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score. Eur Spine J 33, 198–204 (2024). https://doi.org/10.1007/s00586-023-08037-0

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  • DOI: https://doi.org/10.1007/s00586-023-08037-0

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