Emergency Radiology

, Volume 25, Issue 4, pp 415–424 | Cite as

Is elevated body mass index protective against cervical spine injury in adults?

  • Nicholas M. Beckmann
  • Chunyan Cai
  • Susanna C. Spence
  • Mark L. Prasarn
  • O. Clark West
Original Article



Correlate body mass index (BMI) with incidence and type of cervical spine injury seen on CT in adult patients presenting with blunt trauma.

Materials and methods

Retrospective chart review of all adult blunt trauma patients who had a cervical spine CT performed at our level 1 trauma center during an approximately 3-year period.


A statistically significant (p = 0.01) difference in cervical spine injury incidence was present between different BMI groups. Cervical spine injury incidence was 7.7% for underweight (BMI ≤ 18) patients, 7.1% for normal weight (BMI 18–25) patients, 6.2% for overweight/obese (BMI 25–35) patients, and 4.7% for morbidly obese (BMI > 35) patients. Using BMI > 18–25 as a reference group, females with BMI > 25–35 had an adjusted odds ratio (aOR) of 0.56 (CI 0.41–0.75) and females with BMI > 35 had an aOR of 0.42 (CI 0.26–0.70). Males with a BMI ≤ 18 had an aOR of 2.20 (CI 1.12–4.32) and males with BMI > 35 had an aOR of 0.66 (CI 0.46–0.95). A particularly low incidence of cervical spine injury was observed in patients older than 65 in the obese group with a cervical spine injury rate of only 1.4% in this patient population. No statistical significant difference was seen in injury morphology across the BMI groups.


An inverse relationship exists between BMI and the overall incidence of cervical spine injury. This protective effect appears to be influenced by gender with elevated BMI having lower relative odds of cervical spine injury in women than in men. A particularly low rate of cervical spine injury was identified in obese patients over the age of 65. Routine imaging of all elderly, obese trauma patients with low energy mechanism of injury may not be warranted.


Cervical spine Trauma Injury Body mass index Obesity 



1. Memorial Hospital System in Houston.

2. We acknowledge the support provided by the Biostatistics/Epidemiology/Research Design (BERD) component of the Center for Clinical and Translational Sciences (CCTS) for this project. CCTS is mainly funded by a grant (UL1 TR000371) from the National Center for Advancing Translational Sciences (NCATS), awarded to University of Texas Health Science Center at Houston. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCATS.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© American Society of Emergency Radiology 2018

Authors and Affiliations

  • Nicholas M. Beckmann
    • 1
  • Chunyan Cai
    • 2
    • 3
  • Susanna C. Spence
    • 1
  • Mark L. Prasarn
    • 4
  • O. Clark West
    • 1
  1. 1.Department of Diagnostic and Interventional Imaging, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonUSA
  2. 2.Department of Internal Medicine, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonUSA
  3. 3.Biostatistics/Epidemiology/Research/Design Core, Center for Clinical and Translational SciencesThe University of Texas Health Science Center at HoustonHoustonUSA
  4. 4.Department of Orthopedic Surgery, McGovern Medical SchoolThe University of Texas Health Science Center at HoustonHoustonUSA

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