Risk factors for spinal cord injury without radiographic abnormality in trauma cases at a single trauma center

Background: Cervical injury due to blunt trauma requires emergency responses; however, few studies have investigated risk factors based on spinal cord injury without radiographic abnormality (SCIWORA). Therefore, this study determined the risk factors for cervical spinal cord injury with radiographic abnormality and SCIWORA. Materials and Methods: This study included 4923 trauma cases transferred to a Japanese trauma center between 2007 and 2013. We analyzed risk factors for cervical spinal cord injury with radiographic abnormality and SCIWORA using a logistic regression model. The coefficient factors considered for this study were Revised Trauma Score, age at arrival, and cause of injury (traffic accident, ground-level fall, low- and high-level fall, or other injury). Results: Significant independent risk factors of cervical spinal cord injury varied based on the presence or absence of radiographic abnormality. The risk factors for SCIWORA were male (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.21-3.95), age 65 to 79 years (OR, 1.71; CI, 1.06-2.78), Revised Trauma Score <7.8408 (OR, 4.98; CI, 2.42-10.26), Injury Severity Scale (OR, 1.07; CI, 1.06-1.09), other injuries (OR, 2.64; CI, 1.11-6.30), low- and high-level fall (OR, 2.18; CI, 1.24-3.83), and ground-level fall (OR, 10.35; CI, 5.65-18.95). Conclusions: The risk factors for SCIWORA are male, age 65 to 79 years, and ground-level fall. Therefore, careful neurologic examination and magnetic resonance imaging studies are necessary in the examination of these at-risk patients.