The mechanisms and risk factors of spinal cord injury with versus without concurrent vertebral fracture: A Spinal...

Traumatic spinal cord injury (TSCI) without concurrent vertebral fracture is a phenomenon often described in pediatrics. There is limited evidence regarding factors that predispose adults to this rarer injury.

To determine different factors that increase the odds of TSCI without vertebral fracture.

Retrospective case-control study.

Participating sites of the Spinal Cord Injury Model Systems (SCIMS) database.

Patients aged 18 or older presenting at a registered SCIMS center following TSCI between 2006 and 2021.

None.

Logistic regression identified variables associated with TSCI without vertebral fracture (OR > 1).

This study included 2,524 patients, of whom 501 did not suffer a vertebral fracture. Patients with incomplete SCI at cervical levels and those of more advanced age were less likely to have a concurrent vertebral fracture. Penetrating injury (OR = 4.13 [95% CI: 2.72, 6.28], P < 0.0001) and medical/surgical complications (OR = 50.30 [95% CI: 27.80, 95.90], P < 0.0001) dramatically increased the odds of suffering SCI without vertebral fracture compared to non-penetrating injuries. Overall results were similar when only blunt injuries were analyzed, except that complete injuries at T1-S5 (OR = 0.41 [95% CI: 0.17, 0.96], P = 0.044) were associated with vertebral fracture.

Adults may experience biomechanical stresses similar to those proposed in pediatric populations. The findings of this study can be used to screen patients with suspected spinal cord injury without obvious signs of spinal trauma.