Traumatic spinal fractures: epidemiological and clinical evaluation in a forensic medicine clinic sample

Traumatic spinal injuries (TSI) are a major public health concern associated with substantial morbidity. As the first study to provide a regional forensic medicine perspective, this study aimed to retrospectively evaluate the clinical characteristics, etiological factors, injury patterns, and long-term sequelae of traumatic spinal fractures among patients presenting to Department of Forensic Medicine, Atatürk University between 2020 and 2022.

Medical records of 12,029 cases evaluated at the Department of Forensic Medicine, Atatürk University between 2020 and 2022 were reviewed. A total of 277 cases with confirmed spinal fractures were included. Demographic characteristics, etiology, Injury Severity Score (ISS), fracture levels, associated injuries, and treatment methods were analyzed. Long-term sequelae were assessed in 174 patients with at least 12 months of follow-up.

Among the patients, 74.1% were male (male-to-female ratio: 2.85), and the mean age was 40.1±16.69 years. The most common etiology was vehicle occupant motor vehicle accidents (VO-MVA) (56.3%), followed by motor vehicle accidents involving vulnerable road users (VRUs-MVA) (15.5%) and high-energy falls (HEF) (13.4%). A statistically significant association was found between age and etiology (p=0.001); VO-MVA predominated in the 18-44-year age group, whereas VRU-related injuries increased among individuals aged ≥65 years. Injuries resulting from VRUs-MVA and HEFs were significantly associated with major trauma (ISS ≥16) (p=0.044) and multiple vertebral fractures (p=0.001). The thoracolumbar junction (T11-L2) was the most frequently affected region (31.8%). A significant association was identified between head/facial trauma and cervical fractures (odds ratio [OR]=3.59; 95% confidence interval [CI]: 1.89-6.82), and between intra-abdominal organ injuries and sacral fractures (OR=6.47; 95% CI: 2.40-17.39). Permanent sequelae were observed in 50% of patients with follow-up data; the most common were restricted spinal mobility (46.8%) and spinal cord injury (13.5%).

Although vehicle occupant traffic accidents are the most common cause of spinal fractures, accidents involving vulnerable road users and high-energy falls are associated with greater injury severity and multiple fractures. Clinicians should maintain a high index of suspicion for cervical fractures in patients presenting with head trauma and sacral fractures in those with abdominal injuries. Rapid triage and careful evaluation are essential, particularly in cases involving high-energy mechanisms and associated organ injury. These findings highlight the substantial long-term morbidity associated with traumatic spinal fractures and underscore the importance of multidisciplinary follow-up.