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Noncontiguous Spine Injury: Is the Risk Increased in Low-Energy Falls?

Noncontiguous injuries in a different spine region (NCIDSR) have been associated with increased morbidity compared with singleregion spine injuries.1 Studies have estimated the frequency of noncontiguous thoracolumbar spine injuries to be almost 20% when a cervical spine injury has been identified, leading to recommendations for whole spine imaging in this setting. In lowvelocity trauma, however, the prevalence and risks of NCIDSR have not been well studied. The purpose of this study was to determine whether there was an increased risk of NCIDSR in lowenergy falls when a single spine injury was found. We hypothesized that there is no increased risk of NCIDSR after the detection of a spine injury. A retrospective analysis of patients aged ≥18 years was performed over a 6year period (April 2013March 2019) in a Level I trauma center. Patients who sustained falls less or equal to 5 feet were included. Patients with penetrating injuries, unspecified mechanisms of injury, or involvement with any motor vehicle were excluded. The International Classification of Diseases (ICD) ninth and 10th edition codes were used to classify spine injuries (fracture, subluxation, and cord) into cervical (C), thoracic (T), or lumbar (L) spine regions. NCIDSR was defined as noncontiguous spine injuries found in 2 or more different spine regions. Concomitant C7/T1 and T12/L1 injuries were considered contiguous and classified as Cspine and Tspine injuries, respectively, despite being from different spine regions. For further analysis, only patients who underwent computed tomography (CT) imaging of the entire torso and neck were included. Prevalences and relative risks (RR) with 95% CI of NCIDSR were calculated for this cohort. Separate analyses were performed to assess the risks of NCIDSR for the following cohort subsets: age <65 and ≥65 years, the height of fall <2 feet and ≥2-5 feet, Glasgow Coma Scale (GCS) score = 15 and GCS <15. For continuous data, the Kruskal–Wallis test was used. For categorical data, the chisquare test or Fisher’s exact test was used where appropriate. A P value <.05 indicated statistical significance. Statistical analysis was performed using StatsDirect v. 3.2.8 (StatsDirect Ltd., Merseyside, UK). Of 14 429 patients during the study period, 7872 patients met inclusion criteria. Of these, 5859 (74%) patients had CT imaging of the neck and entire torso and formed the basis for further analysis. In this cohort, the median age was 79 (64-87) years, 46% were males and 18.3% fell from a height of more than 2 feet. Of those with GCS scores available (n = 4721), 65.4% had a GCS score of 15. Overall inhospital mortality was 3.6%. The prevalence of spine injuries was 17.7% (single region spine injuries, n = 956 [16.3%] and NCIDSR, n = 81 [1.4%]). Thus, NCIDSR was seen in 7.8% of patients with spine injuries. Overall, 303 (5.2%) patients had Cspine injuries, 452 (7.7%) had Tspine injuries and 368 (6.3%) had Lspine injuries. Of these, spinal cord injuries comprised 13.5%, 0.2%, and 0.2% of the Cspine, Tspine, and Lspine injuries, respectively. Patients with NCIDSR were older, were more likely to be female, were more likely to fall from a height of >2 feet, and had higher Injury Severity Score compared with those with single region spine injuries and no spine injuries (Table 1). In patients with a Cspine injury, the risks of noncontiguous Tspine or Lspine injuries were similar to that in patients without Cspine injuries. A Tspine injury was associated with an increased risk of a noncontiguous Lspine injury (Table 2). The above relationships held true for age (<65 years and ≥65 years), the height of fall Brief Report