Summer Salad

January/February 2009

Upper cervical spine injuries in elderly patients

Volume 38, No.1, January/February 2009 Pages 43-45

M Sami Walid

Nadezhda V Zaytseva


Elderly patients may sustain upper cervical spine injury without neurological symptoms or radiographic evidence of fracture.


This review discusses the prevalence and presentations of upper cervical spine injury in the elderly, and the use of imaging in the evaluation of such injuries.


Typically, upper cervical spine injuries are caused by hyperextension in patients with degenerative changes of the senescent spine. Multiplanar imaging of the cervical spine in elderly patients with persistent post-traumatic head and neck symptoms, even after seemingly minor trauma, is decisive.

Cervical spine (C-spine) injuries are the most feared of all spinal injuries because of the potential for significant deleterious sequelae. In a 1995 study from Russia, 196 patients with spinal cord injury were admitted over 5 years in one centre. Injuries were: cervical, 49.0%; thoracic, 27.5%; and lumbar, 23.5%.1 In the United States, 1.9–3.8% of adult emergency room presentations are for acute C-spine injury due to blunt trauma,2 and as many as 10% of unconscious patients injured in motor vehicle accidents (MVAs) have C-spine injury.3 Motor vehicle accidents, falls and sport trauma are responsible for the majority of emergency department presentations of C-spine injuries.3

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