Clinical profile of patients with traumatic cervical spine injury in the emergency department of a tertiary care hospital.

Sir,

Traumatic cervical spine injury (CSI) is a very disastrous and crippling disease which has a lasting neurological deficit and disability. In India, it is estimated that 20,000 patients have spinal cord injuries and are mostly from the rural population.[1] This prospective observational study was conducted in a Tertiary Hospital in Vellore, South India. The profile of all adult patients presenting with traumatic CSI was studied. The study included 40 patients with CSI during a period of 4 months with an incidence of 1.2% among all trauma cases.[2] The majority of the patients were males (87.5%).[34] In our study, there was an equal distribution of patients between the age group <45 years and >45 years, most of them in the working age group. Road traffic incidents (RTIs) was the most common cause of CSI (62.5%),[4] followed by fall from height (20.0%) and fall on the level ground (17.5%). Two wheeler accidents comprised the majority of RTI (62.5%) followed by four wheeler accidents (20%). The severity of the injury was calculated using the Revised Trauma Score (median score of 8 with an interval of 6-8). Quadriplegia was found to be the most common neurological deficit (23.3%) followed by paraparesis (16.3%), paraplegia (14%), monoparesis (7%), hemiparesis (4.7%), quadriparesis (4.7%), and hemiplegia (2.3%) [Figure 1]. More than one cervical vertebra was injured in 60% of cases. The most commonly injured vertebra was the C5 (21.8%), closely followed by C4 (18.7%) and C6 (20.3%) [Figure 2]. Forty-five percent were unstable injuries. The c5 level is found out to be the most commonly injured cervical spine whereas C1 was found out to be the least affected.[1] Cervical spine trauma is associated with significant morbidity with the lower cervical spine (C3-C7) most commonly involved. Only 10% (4/40) of patients had associated head injury. Associated thoracic vertebra fracture was seen in 2 patients. The majority of patients (87.5%) riding a two wheeler were not wearing a helmet and majority of patients (80%) driving a four wheeler were not wearing a seat belt. Other studies reported only 31% usage of helmets among two wheeler riders in Kerala[5] RTI was the most common cause and hence stricter traffic rules would probably decrease the burden of this devastating injury.

Figure 1

Common neurological manifestation

Figure 2

Common level of cervical spine injury

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Conflicts of interest

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