Clinical epidemiology, management and outcomes of traumatic cervical spinal-cord and spine injuries: a systematic review of 1645 pooled cases.

Introduction: Cervical spine (mostly atlanto-axial) accounts for over half of the acute traumatic disruptions of the spinal cord and its coverings; alongside its persisting neurological deficits. Two-thirds of the etiology were fairly evenly distributed between traffic crashes, falls, assault and other occupation-related injuries. We described the etiological mechanisms, neuro-anatomical level, severity, treatment and outcomes of traumatic cervical spinal-cord and spine injuries (C-SCI+SI).

Evidence acquisition: We systematically reviewed PubMed and Cochrane CENTRAL on 16th May 2023, using a prospectively registered protocol (CRD42023417530). The search strategy combined search words (from the keywords; "cervical spinal cord injury," "conservative" and "operative" "treatment") using Boolean operators. These yielded 787 and 55 records from PubMed (then 223 after delimiting to 10 years) and CENTRAL respectively; after records screening, 106 and 1 record were relevant respectively. Seventy-six reports were recruited for the quasi-quantitative synthesis following full-text review and methodological quality/bias assessment (using Joanna Briggs Institute critical appraisal tools).

Evidence synthesis: Seventy-six reports yielded 1645 pooled cases. Weighted-mean age (N.=1512) was 46.3 years, with male (70.2%; gender N.=1525) preponderance. C-SCI+SI were mostly caused (N.=1079) by falls (42.1%) and road traffic crashes (42.2%); presenting(N.=178) with neck pain (71.4%) mostly and under one-fifth had neurological deficits (-plegias or -paresis, 11.8%; radiculopathy, 6.2%). The commonest vertebral levels (N.=1525) were 23.9% for the second cervical vertebra (c2), c5(20.4%) and c6(20.0%). Treatment (N.=1297) was combined pre-operative non-operative [skull traction (72.0%/842), cervical collar (13.9%/163)] in 90.2%, with solely non-operative (33.9%/439) options also used. Operative implant-based arthrodeses (66.2%/858) were done, using anterior (68.5%), posterior (20.2%/173) and combined (10.4%/89) approaches. Good bony fusion (89.0%) and clinical improvements (43.2%) were reported.

Conclusions: Mostly low-level evidence showed C-SCI+SI occurring more amongst the middle-aged and men; following falls or road traffic crashes. The second, fifth and sixth cervical levels are mostly affected; with excellent post-intervention bony-union, with neurological improvements in two-fifths. Better international reporting standards are advocated.