Diagnostic yield and number needed to screen for cervical and concomitant spinal injuries in geriatric head trauma

Geriatric patients with head trauma face an increased risk of cervical spine injuries (CSI) and concomitant spinal injuries (CoSI). The added value of cervical spine MRI (csMRI) and whole-spine imaging alongside routine cranial CT (cCT) and cervical spine CT remains unclear.

This study evaluates the prevalence and risk factors for CSI, the number needed to screen (NNS) to detect CoSI and the diagnostic yield of csMRI.

Patients aged ≥65 years presenting after head trauma to a Level I trauma center between January 2020 and October 2025, undergoing cCT and cervical spine CT, were analyzed.

A total of 2748 geriatric patients were included, with 63.9% aged ≥80 years and 1.5% showing sensomotoric deficits. CSI occurred in 6.0%, equally affecting axial and subaxial regions. Conservative treatment of CSI was employed in 75.2%, while dorsal instrumentation was the most performed operative technique (63.4%). Risk factors for CSI included advanced age (OR = 1.1, p = 0.03), ankylosing spinal disease (OR = 5.9, p < 0.001) and thoracic trauma (OR = 2.9, p < 0.001). The NNS for incremental yield of csMRI was 54.9 for patients aged ≥65 years and 45.3 for those aged ≥80 years. For CoSI the NNS were 29.4 and 19.3 respectively. Among patients undergoing additional csMRI, subaxial injuries were observed in 45.6%, with 70.0% being treated conservatively.

CSI are common in geriatric head trauma and frequently accompanied by CoSI. Given the low NNS, a liberal use of extended imaging, including whole-spine CT and selective csMRI, can be considered to improve patient safety.

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