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Kuharski MJ, Balmaceno-Criss M, Mansour A, Nadella A, Meininger K, Lou M, Daher M, Alsoof D, Diebo BG, Daniels AH. The Epidemiology of Recreation-Related Cervical and Thoracic Fractures. Spine J 2024:S1529-9430(24)01037-4. [PMID: 39332688 DOI: 10.1016/j.spinee.2024.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/19/2024] [Accepted: 09/14/2024] [Indexed: 09/29/2024]
Abstract
CONTEXT Recreational activities are frequently associated with spinal fracture, yet contemporary characterization of sports-related cervical and thoracic fracture is lacking. PURPOSE To characterize cervical and thoracic fractures associated with recreational activities. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE The National Electronic Injury Surveillance System (NEISS) database OUTCOME MEASURE AND COMPARISONS: Recreation-related cervical and thoracic fracture incidence rates per year, stratified by age and sex. Common causative activities were established by demographics. METHODS The NEISS database was queried to identify patients with recreation-related cervical fractures between 2003 and 2022 and recreation-related thoracic fractures between 2003 and 2022 in patients aged >2 years-old. United States Census data was utilized to generate incidence rates per year. Data was stratified by demographic variables to assess the impact of age and sex on incidence and causative activity. RESULTS Between 2003 and 2022, an estimated 13,823 recreation-related cervical fractures occurred with an average annual incidence of 2.20±0.35 per 1 million person-years, while 24,236 estimated recreation-related thoracic fractures occurred from 2003 to 2022 with an average incidence of 3.85±1.26. Males experienced a 3.51 times higher (95% CI 3.38-3.66) rate of cervical fracture, but thoracic fracture rates were similar between sexes. Individuals under 18 experienced a 2.15 times higher rate of thoracic fractures than those aged 18-64 (95% CI 1.85-2.50) and 1.93 times higher rate than those over 65 (95% CI 1.68-2.22). Recreation-related cervical fracture rates in individuals 18-64 was 1.186 (95% CI 1.14-1.23) times higher than those under 18 and rates in those under 18 were 1.15 (95% CI 1.09-1.22) times higher than those over 65. Football (26.6%), horseback riding (19.7%), and skiing (8.35%) were the primary causes of cervical fractures, and horseback riding (46.8%), football (11.2%), and skiing (10.3%) primarily caused thoracic fractures. Cervical fractures resulted primarily from football in males (24.7%) and horseback riding in females (44.0%). Horseback riding primarily caused thoracic fractures in both sexes (males=21.5%, females=74.7%). Football led causative activities for individuals under 18 (Cervical=42.4%, Thoracic=40.7%), while horseback riding dominated among those aged 18-64 (26.7%, 56.7%) and over 65 (52.8%, 67.9%). CONCLUSIONS This investigation revealed epidemiological trends in cervical and thoracic spinal fractures and underscore the need for targeted preventive measures and safety interventions to mitigate the burden of these fractures particularly in horseback riding and American football.
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Affiliation(s)
- Michael J Kuharski
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Mariah Balmaceno-Criss
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Ali Mansour
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Akash Nadella
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Kathleen Meininger
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Mary Lou
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Mohammad Daher
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Daniel Alsoof
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
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Eng SF, Næss I, Linnerud H, Rønning P, Brommeland T, Evjensvold M, Sundstrøm T, Galteland P, Døving M, Aarhus M, Helseth E, Ramm-Pettersen J. Bicycle-related cervical spine injuries. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 10:100119. [PMID: 35585915 PMCID: PMC9108519 DOI: 10.1016/j.xnsj.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/24/2022] [Accepted: 04/25/2022] [Indexed: 11/20/2022]
Abstract
Background Bicyclists are vulnerable road users. The aim of this paper was to describe all bicycle-related traumatic cervical spine injuries (CSIs) in the South-East region of Norway (2015-2019), and to investigate whether certain types of CSIs are typical for bicyclists. Methods Retrospective cohort study of prospectively collected registry data of all CSIs in the South-East region of Norway (3.0 million inhabitants), from 2015 to 2019. Patient characteristics, injury types, and treatment were summarized with descriptive statistics. Bayesian multivariable logistic regression was used to identify potential factors associated with occipital condyle fractures (OC-Fx) or odontoid fractures (OFx). Results During the five-year study period, 2,162 patients with CSIs were registered, and 261 (12%) were bicycle-related. The incidence of bicycle-related CSIs was 1.7/100,000 person-years. The median age of the patients with bicycle-related CSIs was 55 (IQR: 22) years, 83% were male, 71% used a helmet, 16% were influenced by ethanol, 12% had a concomitant cervical spinal cord injury (SCI), and 64% sustained multiple traumas. The three most common bicycle-related CSIs were C6/C7 fracture (Fx) (28%), occipital condyle Fx (OC-Fx) (23%) and C5/C6 Fx (19%). Patients with bicycle-related CSIs compared to patients with non-bicycle related CSIs were younger, more often male, had fewer comorbidities, more likely multiple traumas, more often had OC-Fx, and less often sustained an odontoid fracture (OFx). Multivariable logistic regression of potential risk factors for OC-Fx demonstrated a significantly increased risk of OC-Fx for bicyclists compared to non-bicyclists (OR=2.8).The primary treatment for bicycle-related CSIs was external immobilization in 187/261 (71.6%) cases, open surgical fixation in 44/261 (16.8%), and no treatment in 30/261 (11.5%). Conclusion Bicycle crashes are a frequent cause of CSIs in the Norwegian population and should be of concern to the public society. The three most common bicycle-related CSIs were C6/C7 fracture, occipital condyle fracture and C5/C6 fracture.
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Key Words
- ASA-PS, American Society of Anesthesiologists physical status
- Bicycling
- CSI, Cervical spine injury
- Fx, Fracture
- GCS, Glasgow coma scale
- Multiple trauma was defined as a simultaneous TBI (mild, moderate, or severe according to HISS) and/or imaging-proven (X-ray, CT, or ultrasound) injury in one or more of the following regions: face, thoracolumbar spine, chest, abdomen, pelvis or extremities. Skin injuries were not registered
- OC-Fx, Occipital condyle fracture
- OFx, Odontoid fracture
- OUH-U, Oslo University Hospital, Ullevål
- Occipital condyle fracture
- Public health
- Spine
- Surgery
- TBI, Traumatic brain injury
- Trauma
- cSCI, Cervical spinal cord injury
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Affiliation(s)
- Svend Filip Eng
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Ingar Næss
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hege Linnerud
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Pål Rønning
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Tor Brommeland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Magnus Evjensvold
- Department of Neuroradiology, Oslo University Hospital, Oslo, Norway
| | - Terje Sundstrøm
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Pål Galteland
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Mats Døving
- Department of Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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