Spinal fractures and/or spinal cord injuries are associated with orthopedic and internal organ injuries in proximity to the spinal injury

BACKGROUND: the demographics, mechanisms of injury, and concurrent injuries associated with cervical, thoracic and lumbar spinal fracture and/or spinal cord injury remain poorly characterized. METHODS: Patients aged 18 and older with spinal injury between 2011 and 2015 in the National Trauma Data Bank (NTDB) were identified. Patient demographics, comorbidity burden, mechanism of injury, and associated injuries were analyzed. RESULTS: in total, 520,183 patients with acute spinal injury were identified including 216,522 cervical, 191,218 thoracic, and 220,294 lumbar. The age distributions were trimodal with peaks in incidence at around 2155 and a lesser peak around 85 years of age. The number of comorbidities increased while injury severity decreased with advancing patient age. Motor vehicle accidents (MVAs) were the most common mechanism of injury. Associated bony and internal organ injuries were common and occurred in 63% of cervical spine injury patients, 79% of thoracic spine injury patients, and 71% of lumbar spine injury patients. In all three sub-populations, there was a predominance of injuries in the local area of the primary injury. For cervical, these were rib injuries (28%), thoracic spine injuries (22%), skull fractures (20%), intracranial injuries (26%) and lung injuries (21%). For thoracic, these were rib injuries (47%), lumbar spine injuries (26%), cervical spine injuries (25%), lung injuries (35%) and intracranial injuries (24%). For lumbar, these were rib injuries (38%), thoracic spine injuries (22%), pelvic fractures (20%), lung injuries (26%) and intracranial injuries (19%). Multivariate regression analysis demonstrated that increased injury severity was strongly correlated with increased mortality, with lesser contributions from increased age and comorbidity burden. CONCLUSIONS: the current study revealed spinal fractures and/or cord injuries had high incidences of associated injuries that had a predominance of local distribution. These findings, in combination with the mortality analysis, demonstrate the importance of local targeted evaluations for associated injuries.