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


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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Crossref Citations

1. Polytrauma patients with severe cervical spine injuries are different than with severe TBI despite similar AIS scores
Karlijn J. P. van Wessem, Menco J. S. Niemeyer, Luke P. H. Leenen
Scientific Reports  vol: 12  issue: 1  year: 2022  
doi: 10.1038/s41598-022-25809-8