Evaluation of the risk of noncontiguous fractures of the spine in blunt trauma.

BACKGROUND: There is significant debate over the risk of additional noncontiguous (NC) fractures among blunt trauma patients with an identified spinal column injury, often prompting routine full-spine imaging. We sought to determine the incidence of NC spinal fractures and the relationship between injury pattern and mechanism.

METHODS: A review of all adult blunt trauma patients from the 2010 National Trauma Data Bank with a spine fracture. Patient demographics, mechanism of injury, and frequencies of all combinations of spinal fractures were analyzed.

RESULTS: Among 654,052 blunt trauma patients, 83,338 (13%) had a diagnosed spine fracture. The mean (SD) Injury Severity Score (ISS) was 15 (11). Of these, 7% (5,496) sustained spinal cord injury, and 17% (14,413) underwent spinal surgery during their index hospitalization. Among those with spinal column fractures, the overall incidence of NC fractures was 19% and was associated with severe truncal injuries, primarily involving the chest. The relative incidences of cervical, thoracic, and lumbar fractures were 41% (34,480), 37% (30,383), and 43% (35,778), respectively. Rates of NC fractures of the spine included 9% cervicothoracic (7,406), 4% cervicolumbar (3,415), and 10% thoracolumbar (7,929). The slight majority (57%) of patients with spinal fractures sustained high-velocity trauma compared with 43% associated with low-velocity trauma. However, NC fractures of the spine were strongly associated with high-velocity trauma.

CONCLUSION: Spine fractures are relatively common with blunt trauma, and approximately 20% of patients with a spinal column fracture will have an NC fracture. NC fractures were associated with other severe injuries and should be mainly suspected and investigated in high-velocity mechanisms.