Date of Award

9-24-2010

Document Type

Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Jonathan Grauer

Abstract

Study Design: Retrospective chart and radiographic review of all patients who underwent CT scans of the cervical spine at a single Level One trauma center over a 10 year period. Objective: To perform a comprehensive survey of all acute cervical spine fractures that were treated at a single institution over the past decade and to define the incidence, associated injuries, and mortality of these fractures. Summary of Background Data: It has been reported that 2-3% of patients experiencing blunt trauma sustain injuries to their cervical spines and fractures/dislocations affecting this region may bring about a number of potentially devastating consequences including neurologic compromise, permanent disability, or even death. Understanding the commonly concomitant injuries and the mortality associated with fractures helps to improve care and guide interventions. Methods: All radiographic records for patients who received CT scans of the cervical spine at a single level one trauma center over a ten year period were reviewed. Those with acute cervical fractures were identified and further evaluated. Medical records of those with acute, non-penetrating fractures were reviewed and clinically significant associated injures were identified. All subjects with acute cervical fracture were evaluated for possible mortality by the National Death Index, a database maintained by the National Center for Health Statistics. Results: Odontoid fractures exhibited a bimodal distribution with the majority affecting the elderly and a smaller peak in younger individuals. Occipital condyle fractures had the highest rates of associated injuries which were significantly higher than the rates of associated injury seen in the study population as a whole (driven by extra-spinal injuries of which head and neck, non-spinal orthopaedic, and intra-thoracic injuries were more common). For the other cervical levels, there was more uniformity than differences for the associated injuries seen. Our study shows that male subjects with odontoid or subaxial fractures have increased mortality from their injury. This mortality risk is greatest in the first 3 months and normalizes to the general population after 1-year and little excess mortality is seen between the first and second year after fracture. Conclusions: The findings of this investigation confirm that the upper and lower regions of the cervical spine appear to be predisposed to injury. For patients with cervical spine fracture/dislocations, associated injuries were found to have similar frequencies regardless of the level of primary injury except for occipital condyle and C7 injuries, for which greater associated injures were observed (potentially related to higher energy mechanisms). After adjusting for differing age population, the mortality risk and survival curves of odontoid and subaxial fractures are notably similar. In summary, a patient with an odontoid or subaxial fracture who survives the initial 3-month period can expect to see little excess mortality for the fracture in the long-term.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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