gms | German Medical Science

Objective: Cervical spine injury (CSI) is frequently associated with debilitating spinal cord damage. As injury patterns and treatment paradigms have changed over the last decade, we proposed to analyze a contemporary neurosurgical series, with particular attention to injury mechanism, treatment and neurological outcome.

Method: We retrospectively analyzed all cervical spine injuries admitted to the neuro-surgical department of a tertiary care center between January 2003 and June 2013. Inclusion criterion for patients with CSI was a trauma requiring neurosurgical management after interdisciplinary discussion; exclusion criteria were: absent neurosurgical lesion or spinal cord injury without radiological abnormality (SCIWORA) or incomplete data sets. Clinical and imaging records were assessed for clinical, radiological, surgical information and follow-up data.

Results: A total of 258 patients with CSI were identified (55 % males, 45 % females). The mean age was 56 ± 22 years; 56% were younger than 65 years. The mean follow-up was 75 ± 40 (8-161) months. The main injury causes were: falls (44%), traffic (14%) and sports accidents (12%). In 234 cases (90%) a fracture was diagnosed. The distribution along the upper, middle and lower cervical spine was: 40%, 52% and 8%, respectively. 34% had a spinal cord injury; amongst those 18 % were ASIA grade A, 24 % grade B, 23 % grade C, 32 % grade D and 3 % grade E. 36 patients (14 %) fulfilled the criteria of a polytrauma with a mean Injury Severity Score of 29 ± 13 (4-51). Head injuries were commonly associated (35%). The mean hospital stay was 9 ± 7 (1-62) days, length of ICU stay was 2 ± 5 (1-34) days and in-hospital accident related mortality was 7.3%. 181 patients (70%) underwent surgical treatment, in most cases within 24h. After surgery 18 % regained a full neurological recovery, 20 % improved in one ASIA grade and 17 % in 2 or more ASIA grades; 45% of the patients remained unchanged.

Conclusions: Compared to the literature the principal causes of CSI remained unchanged over the last decade. In contrast, the total number and rate of patients with severe neurological impairment diminished. This is partly explained by external factors (e.g. security regulations), but most importantly by early and adequate neurosurgical intervention.