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  4. Blunt Cerebrovascular Injury in the Elderly With Traumatic Cervical Spine Injuries: Results of a Retrospective Multi-Center Study of 1512 Cases in Japan

Blunt Cerebrovascular Injury in the Elderly With Traumatic Cervical Spine Injuries: Results of a Retrospective Multi-Center Study of 1512 Cases in Japan

Journal of Neurotrauma, 2023 · DOI: 10.1089/neu.2022.0180 · Published: June 1, 2023

Spinal Cord InjuryAgingTrauma

Simple Explanation

This study investigates blunt cerebrovascular injuries (BCVI) in elderly Japanese patients with traumatic cervical spine injuries (CSI), including spinal cord injury (SCI). BCVI involves damage to blood vessels in the brain due to blunt force trauma. The research found that a small percentage of elderly patients with CSI also experienced BCVI, and certain factors like head injury and specific types of cervical fractures increased the risk of BCVI. Early diagnosis of BCVI is crucial to prevent complications such as brain infarction and death. The study suggests that elderly patients with CSI and certain risk factors should be screened for BCVI.

Study Duration
2010 to 2020
Participants
1512 patients (average age: 75.8 – 6.9 years; 1007 males, 505 females)
Evidence Level
Not specified

Key Findings

  • 1
    3.5% of elderly patients with CSI were complicated with BCVI.
  • 2
    BCVI more frequently complicated head injury, severe neurological deficit (ASIA A or tetraplegia), AO type F, and/or C fractures and cervical dislocation.
  • 3
    Mortality and brain infarction rates in the elderly Japanese patients with CSI complicated by BCVI were 0.13% and 0.40%, respectively.

Research Summary

The study aimed to determine the incidence and characteristics of blunt cerebrovascular injury (BCVI) in elderly Japanese patients with traumatic cervical spine injuries (CSI). The results showed that 3.5% of elderly patients with CSI had BCVI, and risk factors included head injury, severe neurological deficits, and specific types of cervical fractures and dislocations. The study concludes that BCVI screening is necessary for elderly CSI patients with these risk factors to prevent complications like brain infarction and death.

Practical Implications

Enhanced Screening Protocols

Implement routine BCVI screening for elderly patients with CSI who present with head injury, severe neurological deficits (ASIA A SCI and tetraplegia type), specific cervical fracture types (AO type F, BL, C), and cervical dislocation at C1-6 levels.

Risk Factor Awareness

Increase awareness among clinicians regarding the elevated risk of BCVI in elderly CSI patients with the identified risk factors, even in cases of low-energy trauma.

Treatment Strategies

Develop tailored treatment strategies for BCVI in elderly CSI patients, considering the Denver grading scale and individual patient characteristics, to minimize complications such as brain infarction and mortality.

Study Limitations

  • 1
    Retrospective study design
  • 2
    Data limited to Japanese population
  • 3
    Unknown causes of delayed brain infarction

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