(O-B1) A retrospective Cohort Study to Determine the Injury Prevalence of Cervical Spine Injuries in Elderly Patients Undergoing Full Trauma CT

Objectives: The aim of the study was to determine the prevalence of cervical spine injuries and injury patterns in elderly patients (>65 years) with low energy injuries who underwent a pan trauma CT.

Background: Cervical spine injuries sustained from low energy injuries or falls are often relatively occult due to the absence of significant cervical spine symptoms or pre-existing arthritis. There is some debate as to the whether the pan CT should be undertaken in all elderly fallers. Recent evidence has shown that cervical spine fragility fractures are uncommon in the elderly fallers due to a higher bone density in this region(1). In contrast osteoarthritis of the cervical spine is common and has been shown to be a risk fracture for cervical spine fractures(2).

Methods: The Emergency Department at North Manchester General Hospital automatically undertakes a pan CT in elderly patients with one or more of the following:- haemodynamic instability; evidence of chest wall tenderness; evidence of respiratory compromise; multi-level spinal pain; cervical spine tenderness plus evidence of torso injury or high impact injury. The CT scan reports, and clinical notes were reviewed of all elderly patients (over 65 years of age) who had a full trauma CT (head, neck, chest, abdomen and pelvis) over a twelve-month period (September 2020 – September 2021). The number of patients with cervical spine fractures and their age was recorded. The type and location of cervical spine injuries was also recorded.

Results: Sixty-six elderly patients underwent a full trauma series over the twelve-month period. High impact injuries and haemodynamic instability account for a small number of patients because the Emergency Department at North Manchester General Hospital is a non-trauma centre. The mean age of the cohort was 83.2 years, 26% (n= 17) of the patients in the cohort were aged 90 years or over. 39% (n=26) of the patients were identified to have a least one injury detected on CT scan. 86% (n=57) were due to ground level falls. Three patients out of sixty-six were noted to have cervical spine fractures (4.5%). One patient was an isolated C2 fracture, one patient had a C2 fracture with an associated T4 fracture and the third patient had a C5 fracture with an associated T1 and occipital fracture.

Conclusions: The results of this study demonstrated that 4.5% of elderly patients sustained cervical spine injuries following low level falls. 39% of the cohort had at least one significant injury identified by the pan CT. The results from this study justify a fairly liberal approach to the use of the pan trauma CT in elderly patients.

References (Optional): 1. Schoder G., Hiepe L., Moritz M et al.
Why insufficiency fractures are rarely found in the cervical spine even with osteoporosis.
Z Orthop Unfall. 2022. Dec; 160(6): 657-669.
2.CT evaluation of the pattern of odontoid fractures in the elderly-relationship to upper cervical spine osteoarthritis.
Lakshmanan P., Jones A., Lyons K.
Eur Spine J. . 2005. Feb; 14(1): 78-83.

Funding (Optional): None