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Epidemiology of Traumatic Cervical Spinal Fractures in a General Western Population


 Background: In Western countries, the typical cervical spine fracture (CS-Fx) patient has historically been a young male injured in a road traffic accident. Recent reports and daily clinical practice clearly indicate a change in the typical patient from a young male to an elderly male or female with comorbidities. This study aimed to establish contemporary population-based epidemiological data of traumatic CS-Fx for use in health care planning and injury prevention.Methods: This is a population-based clinical observational cohort study from the southeastern region of Norway with 3.0 million inhabitants. We included all patients diagnosed with a CS-Fx between 2015 and –2019. Information regarding demographics, preinjury comorbidities, trauma mechanisms, injury description, treatment, and level of hospital admittance is presented.Results: We registered 2153 patients with CS-Fx during a 5-years period, with an incidence of CS-Fx of 14.9/100,000 person-years. The median patient age was 62 years, 68% were males, 37% had a preinjury severe systemic disease, 16% were under the influence of ethanol, 53% had multiple trauma, and 12% had concomitant cervical spinal cord injury (incomplete in 85% and complete in 15%). The most common trauma mechanisms were falls (57%), followed by bicycle injuries (12%) and 4-wheel motorized vehicle accidents (10%). The most common upper CS-Fx was C2 odontoid Fx, while the most common subaxial Fx was facet joint Fx involving cervical level C6/C7. Treatment was external immobilization with a stiff neck collar alone in 65%, open surgical fixation in 26% (giving a 3.7/100,000 person-years surgery rate), and no stabilization in 9%. The overall 90-day mortality was 153/2153 (7.1%).Conclusions: This study provides an overview of the extend of the issue and patient complexity necessary for planning the health care management and injury prevention of CS-Fx. We suggest intensified fall preventive measures in the elderly, better public awareness of the risks of excessive ethanol use, and better road safety for bicyclists.