Incidence of combined cranial and cervical spine injuries in patients with blunt minor trauma: are combined CT examinations of the head and cervical spine justified?

Abstract

Background The use of computed tomography (CT) scans of the head and cervical spine has markedly increased in patients with blunt minor trauma. The actual likelihood of a combined injury of head and cervical spine following a minor trauma is estimated to be low. Purpose To determine the incidence of such combined injuries in patients with a blunt minor trauma in order to estimate the need to derive improved diagnostic guidelines. Material and Methods A total of 1854 patients were retrospectively analyzed. All cases presented to the emergency department and in all patients combined CT scans of head and cervical spine were conducted. For the following analysis, only 1342 cases with assured blunt minor trauma were included. Data acquisition covered age, sex, and presence of a head injury as well as presence of a cervical spine injury or both. Results Of the 1342 cases, 46.9% were men. The mean age was 65.6 years. CT scans detected a head injury in 116 patients; of these, 70 cases showed an intracranial hemorrhage, 11 cases a skull fracture, and 35 cases an intracranial hemorrhage as well as a skull fracture. An injury of the cervical spine could be detected in 40 patients. A combined injury of the head and cervical spine could be found in one patient. Conclusion The paradigm of the coincidence of cranial and cervical spine injuries should be revised in patients with blunt minor trauma. Valid imaging decision algorithms are strongly needed to clinically detect high-risk patients in order to save limited resources.

Head injuries and the risk of concurrent cervical spine fractures

“…In contrast to our results, there are several reports in the literature stating that HI is not an independent risk factor for CSI [6,8,23,25,26]. Some of the incoherence between the reported coincidence of TBI and CSI may derive from the differences in the study populations and methods used in different studies.…”

“…To what extent head trauma severity is associated with concomitant CSIs is controversial and depends largely upon the study methods and population studied. Vahldiek et al did not find an association between positive head CTs and CSIs in their study that comprised only low-energy injuries [25]. Several studies have included only CT-positive or unconscious HI patients [2,8,12,23,24].…”

“…For comparison, the characteristics of the patients with positive head CT scans (n=269) are presented parallel with the patients with negative head CT scans (n=822) and the whole study sample (n=1091). Of all the patients (n=1091), 607 (55.6%) fulfilled the clinical criteria for mild TBI, 201 (18.4%) had a moderate or severe TBI and the rest (n=283, 25.9%) having a head trauma without clear signs of TBI. Cervical spinal cord injury was found in 13 (16.9%) of the CSI patients.…”

Cervical spine computed tomography motion artifact mimicking spine injury in a patient with severe head injury

“…[ 2 ] The easiest method has been to extend the cranial CT scan to craniocervical CT scan. [ 10 ] It is very fast, easy, and reliable but cervical spine CT artifact can mimic spinal instability thereby subjecting the patient to the risk of unneeded surgery or diagnostic puzzle to the clinicians. [ 7 ]…”

“…Routine spine X-ray has been replaced with more sophisticated computed tomography in evaluation of spine trauma. [ 6 , 10 ] The latest technology of CT scanning is not without its own demerit which includes various artifacts which may affect clinical decision making. [ 2 , 8 , 11 ] In such circumstances, simple static radiograph of the spine may be adequate to resolve the puzzles.…”