What Is the Epidemiology of Cervical and Thoracic Spine Fractures?

Abstract

Background: Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury.

Question/purpose: What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021?

Methods: The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition.

Results: The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period.

Conclusion: This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age.

Level of evidence: Level III, prognostic study.

Fig. 1

This figure shows the incidence of fractures (solid line) with 95% CIs (error bars) during the study period reported as yearly incidence with yearly NEISS estimates for male (hatched pattern) and female (no pattern) sex represented as stacked bars. Shaded gray areas represent the years after 2019 when the NEISS changed its sampling method. (A) This chart shows the incidence of cervical fractures per year whereas (B) this chart shows the incidence of thoracic fractures per year.

Fig. 2

This figure shows the incidence (lines) with 95% CIs (error bars) of cervical and thoracic fractures stratified by sex and age. Shaded gray areas represent the years after 2019 when the NEISS changed its sampling method. (A) This graph shows cervical (left) and thoracic (right) fracture incidence rates for female patients (dashed line) and male patients (solid line). (B) This figure shows cervical (left) and thoracic (right) fracture incidence rates by age group.

Fig. 3

This figure shows the location of injury for fractures, reported as a percentage over time (lines) with 95% CIs (error bars). Shaded gray areas represent the years after 2019 when the NEISS changed its sampling method. (A) This figure shows fractures occurring at home in black (solid line), public property in blue (dashed line), and recreation/sports facilities in orange (dashed-dot line). (B) The proportion of female sex in blue (dashed line) and male sex in black (solid line) that sustained a fracture at home is shown here. (C) This graph shows the proportion of female patients (blue dashed line) and male patients (black solid line) that sustained a fracture at a recreation/sports facilities. A color image accompanies the online version of this article.

Fig. 4

This figure shows injury mechanism for fractures, reported as a percentage over time (lines) with 95% confidence intervals (error bars). Shaded gray areas represent the years after 2019 when the NEISS changed its sampling method. (A) This graph shows fractures caused by falls in blue (dashed line), sports injury in black (solid line), and other in orange (dashed-dot line). (B) This figure shows the proportion of female patients in blue (dashed line) and male patients in black (solid line) with fractures caused by falls. (C) This graph shows the proportion of female patients (blue dashed line) and male patients (black solid line) with fractures caused by sports injuries. A color image accompanies the online version of this article.

Fig. 5

This figure shows the disposition for fractures, reported as a percentage over time (lines) with 95% CIs (error bars). Shaded gray areas represent the years after 2019 when the NEISS changed its sampling method. (A) This figure shows patients with fractures who were admitted in black (solid line) and patients with fractures who were treated and released in blue (dashed line). (B) This graph shows the proportion of female sex in blue (dashed line) and male sex in black (solid line) with fractures who were admitted. (C) This figure shows the proportion of female patients (blue dashed line) and male patients (black solid line) with fractures who were treated and released. A color image accompanies the online version of this article.