Related Experiment Video
Updated: Mar 3, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Asymptomatic cervical spine fractures: Current guidelines can fail older patients
Christopher D Healey1, Sarah K Spilman, Bradley D King
1From the General Surgery Residency Program (C.D.H.), UnityPoint Health, Des Moines, Iowa; Department of Trauma Services (S.K.S., C.A.P.), UnityPoint Health, Des Moines, Iowa; Iowa Radiology (B.D.K.), Des Moines, IA; Neurosurgical and Spinal Surgery (J.E.S.), The Iowa Clinic, Des Moines, IA, and Trauma Surgery (C.A.P.), The Iowa Clinic, Des Moines, Iowa.
Background:
Older adults represent a growing proportion of trauma patients treated in the United States, and cervical spine (c-spine) fracture is an injury that is increasingly common in this population. Neck pain is a major component of current clinical clearance guidelines, but some older adults with c-spine fractures report no neck pain after injury. The objective of this study was to investigate the frequency at which c-spine fractures were unassociated with neck pain in an aging population.
Methods:
A retrospective review was performed for patients 55 years or older with a c-spine fracture during a 4-year study period. All patients had a Glasgow Coma Scale score of 15 and were considered asymptomatic if they did not complain of neck pain on initial presentation, denied tenderness to palpation of the c-spine on examination, and were without neurologic deficit. Differences between groups were assessed with Kruskal-Wallis and χ tests.
Results:
Of 173 patients with c-spine fractures, 36 (21%) were asymptomatic and reported no neck pain on presentation or on examination. The group without neck pain had higher median injury severity scores (15 vs 10; p < 0.001), were more likely to have another injured body region (69% vs 42%; p = 0.004), and had longer hospitalization (7 vs 5 days; p = 0.008) than patients with neck pain. Twenty-two percent of the symptomatic group and 19% of the asymptomatic group required halo, fusion, or other surgical intervention.
Discussion:
Study results indicate that one fifth of patients with a c-spine fracture reported no pain on initial presentation and denied tenderness to palpation on examination. The presence or absence of pain may be an unreliable indicator of c-spine fracture in an aging population. When used in conjunction with existing clearance guidelines, denial of pain may lead to missed injury. We recommend liberal c-spine imaging for older trauma patients with significant mechanism of trauma.
Level Of Evidence:
Therapeutic study, level III.
