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Incidental Cervical Spine Stenosis by Race and Ethnicity Among Trauma Patients: A Retrospective Cross-sectional
Benoit Kindo1, Jacob Welch2, David Zurita3
1Department of Orthopaedic Surgery, St. Elizabeth Youngstown Hospital, Youngstown, Ohio; Northeast Ohio Medical University (NEOMED), Rootstown, Ohio.
Background:
Congenital cervical spine stenosis is an anatomical narrowing of the cervical spine canal, an aberrant anatomy, which can predispose patients to a wide variety of spinal injuries in undiagnosed individuals, even in the setting of minor trauma. Life-threatening injuries with premature career endings are not uncommon among athletes with undiagnosed congenital cervical stenosis sustaining cervical trauma and are well reported in many news outlets. Unfortunately, no clear consensus regarding diagnostic workup and universal guidelines regarding return to play exist. A similar imbroglio exists over criteria and parameters used to screen and diagnose the condition, as well as the demographics and epidemiology of congenital cervical spine stenosis due to limited evidence.
Purpose:
The goal of this retrospective study is to investigate the prevalence of congenital cervical spine stenosis by race.
Study Design:
Large level 1 trauma center retrospective cross-sectional study PATIENT SAMPLE: A total of 381 trauma patients with unremarkable cervical spine CAT scan from 01/01/2013-12/31/2023 OUTCOME MEASURES: The mid-sagittal canal diameter (SCD) and the interpedicular distance (IPD) were measured from C3-T1 using criteria established by Bajwa, SCD < 13 mm and IPD < 23 mm as cut points for cervical spine stenosis, with sensitivity and specificity of 88-100% at each cervical vertebral body.
Methods:
A total of 797 patients were reported in the registry; 416 met exclusion criteria. ßDemographic variables, such as age, gender and race, were collected. All patients with a history of cervical spine injury, previous surgeries, and pre-existing anomalies, including lesions, mass, deformity and technical artifact, were excluded. The mid-sagittal canal diameter (SCD) and the interpedicular distance (IPD) were measured from C3-T1.
Results:
Three hundred and eighty-one (381) patients met inclusion criteria: 306 (81%) were White, 70 (19%) were Black, 3 (0.78) identified as Asian, and 2 (0.52) were American Indian. In the Asian and American Indian groups no cervical level met the criteria of stenosis as defined by an SCD <13 mm and IPD <23 mm. For both the White and Black participant groups, C3-C4 was found to have the narrowest canal diameter with an average SCD of 13.57 ± 1.63and IPD 21.83 ± 1.53. The White participant group prevalence was 15.4% at C3-C4, compared to 21.4% among the Black participant group.
Conclusion:
This study revealed a high prevalence of congenital cervical stenosis within a trauma population with a higher prevalence within the Black participant group. Additionally, C3-C4 was found the most commonly affected level, as opposed to previous reports at C5. Providers must remain vigilant for stenosis in at-risk populations.