Epidemiology
Cervical spine injuries result primarily from motor vehicle accidents, falls, sports activities (e.g., rugby, horse riding, trampolining), and diving into shallow water. Traffic accidents were typically the most common cause of spinal cord injury, followed by falls in the elderly population.[4] The UK Department of Transport estimates that there were 66,805 reported road casualties of all severities in 2019; of these 486 were reported by police as 'broken neck or back' and 18,200 as 'whiplash or neck pain'.[5] The incidence of crash-related neck injury varies widely among European countries, with the highest rates reported in the UK and the lowest rates in France and Finland.[6] Injury mechanisms other than traffic accidents constitute substantially smaller fractions of neck injuries, and are primarily dependent on the activities of the injured people. The majority of studies show a high male-to-female ratio and an age of peak incidence of under 30 years, with approximately 80% of cervical spine injuries occurring in people aged 18-40 years.[4][7][8] Multiple studies have indicated a higher frequency of whiplash injury in women than in men (0.5 to 3.0 occurrence ratio).[9]
Risk factors
Multiple studies have indicated a higher frequency of whiplash injury in women than in men (0.5 to 3.0 occurrence ratio).[9]
Cervical spine injuries are encountered at all ages, but approximately 80% of injuries occur in patients aged 18-40 years.[8] This age group is generally associated with higher-velocity injuries consequent to motor vehicle accidents, while older people experience cervical spine injuries (often fractures) from relatively minor mechanisms of injury (e.g., falling from standing).
A fall from a height >1 metre or 5 steps, or an axial load to the head (e.g., diving, high-speed motor vehicle collision, rollover motor accident, ejection from a motor vehicle, accident involving motorised recreational vehicles, bicycle collision, horse riding accident) are considered dangerous mechanisms of injury.[13][14]
Injuries such as limb fractures or chest and abdominal injuries can make the assessment of cervical spine difficult. Approximately one third of patients with cervical spine and/or spinal cord injuries have an associated head injury.[17] See our topic Assessment of traumatic brain injury, acute.
A more relaxed occupant is more likely to be injured in a collision.[18]
The greater the rotation, the greater the unilateral loading force on the cervical facet joints.[19]
Prior whiplash injury predisposes a person to a poorer prognosis following a second injury.[20]
Any biomechanical risk factor for injury is likely to lead to greater injury risk. Conditions associated with increased risk of cervical spine fracture or cord injury after trauma include spinal stenosis, osteoporosis, and arthritis. Patients with ankylosing spondylitis, particularly in older age groups, are at particular risk of C-spine fractures, and of serious complications and death.[21][22] Chiari malformation, os odontoideum (failed fusion at the base of the odontoid), and other conditions have been reportedly made symptomatic or aggravated by cervical spine trauma.[23]
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