Original Research

Concurrent cranial and cervical spine injuries by associated injury mechanisms in traumatic brain injury patients

Pilasande Hlwatika, Timothy C. Hardcastle
South African Journal of Radiology | Vol 26, No 1 | a2321 | DOI: https://doi.org/10.4102/sajr.v26i1.2321 | © 2022 Pilasande Hlwatika, Timothy Craig Hardcastle | This work is licensed under CC Attribution 4.0
Submitted: 14 October 2021 | Published: 24 March 2022

About the author(s)

Pilasande Hlwatika, Department of Radiology, Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal, Durban, South Africa
Timothy C. Hardcastle, Trauma Service and Trauma ICU, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Surgical Sciences, University of KwaZulu-Natal, Durban, South Africa

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Background: The incidence of concurrent traumatic brain injury (TBI) and cervical spine injury (c-spine) is relatively high, with a variety of risk factors.

Objectives: The purpose of this study was to determine the incidence and related factors associated with combined cranial and c-spine injury in TBI patients by assessing their demographics and clinical profiles.

Method: A retrospective study of patients attending the Trauma Centre at the Inkosi Albert Luthuli Hospital as post head trauma emergencies and their CT brain and c-spine imaging performed between January 2018 and December 2018.

Results: A total of 236 patients met the criteria for the study; 30 (12.7%) patients presented with concurrent c-spine injury. Most TBI patients were males (75%) and accounted for 70% of the c-spine injured patients. The most common mechanism of injury with a relationship to c-spine injury was motor vehicle collisions (MVCs) and/or pedestrian vehicle collisions (70%). The risk factors associated with c-spine injury in TBI patients were cerebral contusions (40%), traumatic subarachnoid haematomas (36%) and skull fractures (33.3%). The statistically significant intracranial injury type more likely to have an associated c-spine injury was diffuse axonal injury (p = 0.04).

Conclusion: The results suggest that concurrent TBI and c-spine injury should be considered in patients presenting with a contusion, traumatic subarachnoid haematoma and skull fracture. The high incidence of c-spinal injury and more than 1% incidence of spinal cord injury suggests that c-spine scanning should be employed as a routine for post MVC patients with cranial injury.


concurrent cranial injury; cervical spine injury; post-traumatic coma; radiation; computed tomography scan


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