Screening for cervical traumatic spine injury is routine in patients with traumatic brain injury (TBI). Cervical traumatic spine injury frequently occurs concomitantly with TBI, is associated with worse outcomes and influences clinical management.
Injury to the thoracolumbar spine at the time of TBI is also associated with poor outcomes, but it can be more difficult to diagnose. There is little time for extraneous testing before treating the head injury.
To determine when additional imaging may be advisable, Hasan A. Zaidi, MD, director of spine research at the Computational Neurosurgical Outcomes Center (CNOC) and co-director of the Adult Spinal Deformity and Scoliosis Program in the Department of Neurosurgery at Brigham and Women’s Hospital, Blake M. Hauser, an MD-PhD candidate at the CNOC, and colleagues identified common risk factors for thoracic and lumbar spinal fractures in TBI. Their report appears in Injury.
The researchers conducted a retrospective study of the National Trauma Data Bank, a prospectively collected and validated database that includes trauma facilities across the U.S. They identified 768,718 adults who had a skull fracture or intracranial injury between 2011 and 2014, including 46,654 (6.1%) who had thoracic spine fractures and 42,801 (5.6%) who had lumbar spine fractures.
Thoracic Spine Fracture
Risk factors significantly associated with thoracic spine fracture were:
- Upper extremity injury—adjusted OR (aOR), 2.19
- Abdominal injury—aOR, 2.02
- Severe TBI according to the Glasgow Coma Scale—aOR, 1.71
- Lower extremity injury—aOR, 1.38
- Obesity—aOR, 1.39
- Epidural hematoma—aOR, 1.36
- Moderate TBI—aOR, 1.26
- Smoking—aOR, 1.09
Protective factors were:
- Subdural hematoma—aOR, 0.86
- Facial injury—aOR, 0.88
Lumbar Spine Fracture
Risk factors significantly associated with lumbar spine fracture were:
- Thoracic injury—aOR, 4.45
- Lower extremity injury—aOR, 2.50
- Obesity—aOR, 1.29
- Severe TBI—aOR, 1.17
- Upper extremity injury—aOR, 1.15
- Moderate TBI—aOR, 1.13
- Comorbid smoking—aOR, 1.12
- Epidural hematoma—aOR, 1.11
Protective factors were:
- Subdural hematoma—aOR, 0.88
- Facial injury—aOR, 0.79
Clinical Judgment Is Preeminent
If validated prospectively, these findings will identify patients presenting with TBI who are likely to have concomitant thoracic or lumbar spine injuries. Those without risk factors could avoid additional screening, which would reduce their time to treatment, radiation exposure and the financial burden of care.
The most important consideration is whether a physician strongly suspects a patient presenting with TBI has a thoracic or lumbar spine fracture, as missed spinal trauma can be devastating.