From the Russell H. Morgan Department of Radiology and Radiological Science (M.R., S.Z., D.M.Y.), Johns Hopkins Medical Institution, Baltimore, Maryland.
Tehran University of Medical Sciences (A.T.), Tehran, Iran.
AJNR Am J Neuroradiol. 2024 Nov 7;45(11):1723-1729. doi: 10.3174/ajnr.A8416.
There has been a distinction made in the 2001 Canadian C-Spine Rule regarding patients 65 and older and younger than 65 years of age as far as indications for cervical spine CT scanning. We sought to determine if there are differences in the symptoms, mechanisms of injury, fracture locations, and types that are still relevant in 2024.
The institutional review board approved this retrospective study of cervical spine CT emergency department results from 2 hospitals in our health system after reviewing 5 years of data in patients experiencing trauma. In addition to the primary variable of age (younger than 65 years and 65 years and older), we looked at injury mechanism, fracture types, sites, symptoms, and operative or medical treatments. Because the demographics of our home site is different from most towns in the United States, we provide race/ethnicity data.
Of 21,986 cervical spine CTs, 190/9455 (2.0%) participants 65 years of age and older and 199/12,531 (1.6%) participants younger than 65 years of age had fractures (total, 389/21,986, 1.8%). There were more cases of falls from standing (106, 55.8%) and falls from a height (46, 4.2%) in those 65 years and older and this mechanism was associated with a higher risk of C1 and C2 fractures (52, 27.4%; and 78, 41.1%, respectively). Among the C1 fractures, anterior and posterior arch fractures predominated (37, 19.5%). For C2 fractures, types 2 and 3 odontoid fractures (39, 20.5%; and 12, 6.3%) were more common in the older cohort. Motor vehicle collisions were more common in the younger cohort (89, 44.7%), and they were associated with more C5-C7 fractures (47, 23.6%; 60, 30.2%; and 66, 33.2%, respectively) including the facets (49, 24.6%), spinous processes (31, 15.6%), and transverse processes (52, 26.1%). Overall, the rates of instability, surgical intervention, and asymptomatic fractures were similar in the 2 age groups.
Cervical spine fractures appear in about 1.8% of the CT scans performed in a busy emergency department environment. Fractures in the elderly occur more commonly due to falls, are located at C1 and C2, and may involve ligamentous injuries. Younger patients incur trauma more commonly due to motor vehicle collisions, and they are more likely to affect the posterior elements, especially C5-C7. The differences in trends for fractures in the 65 years of age and older and younger than 65 years of age groups have persisted since the Canadian C-Spine Rule 1996-1998 data were collected.
2001 年加拿大颈椎 C 规则对 65 岁及以上和 65 岁以下的患者在颈椎 CT 扫描指征方面进行了区分。我们试图确定在 2024 年是否仍存在相关的症状、损伤机制、骨折部位和类型的差异。
在对我们医疗系统两家医院的 5 年急诊颈椎 CT 结果进行回顾后，机构审查委员会批准了这项回顾性研究。除了年龄（65 岁及以上和 65 岁以下）这一主要变量外，我们还观察了损伤机制、骨折类型、部位、症状以及手术或药物治疗。由于我们医院所在地区的人口统计学特征与美国大多数城镇不同，因此我们提供了种族/民族数据。
在 21986 例颈椎 CT 中，190/9455（2.0%）名 65 岁及以上和 199/12531（1.6%）名 65 岁以下的患者有骨折（总计 389/21986，1.8%）。65 岁及以上患者中，更多的是从站立处跌倒（106 例，55.8%）和从高处坠落（46 例，4.2%），这种机制与 C1 和 C2 骨折的风险更高相关（52 例，27.4%；和 78 例，41.1%）。在 C1 骨折中，前弓和后弓骨折更为常见（37 例，19.5%）。对于 C2 骨折，类型 2 和 3 齿状突骨折（39 例，20.5%；和 12 例，6.3%）在老年组更为常见。年轻患者中，机动车碰撞更为常见（89 例，44.7%），与 C5-C7 骨折更为相关（47 例，23.6%；60 例，30.2%；66 例，33.2%），包括关节突（49 例，24.6%）、棘突（31 例，15.6%）和横突（52 例，26.1%）。总的来说，2 个年龄组的不稳定、手术干预和无症状骨折的发生率相似。
在繁忙的急诊环境中进行的颈椎 CT 扫描中，约有 1.8%的患者出现颈椎骨折。老年人的骨折更常见于跌倒所致，位于 C1 和 C2，可能涉及韧带损伤。年轻患者因机动车碰撞造成的创伤更为常见，更容易影响后部结构，特别是 C5-C7。自加拿大颈椎 C 规则 1996-1998 年的数据收集以来，65 岁及以上和 65 岁以下患者的骨折趋势差异一直存在。
