J Surg Res. 2026 Jul 10;326:212-218. doi: 10.1016/j.jss.2026.06.029. Online ahead of print.
ABSTRACT
INTRODUCTION: The incidence and pattern of blunt traumatic injury are believed to correlate with what bioengineers termed imparted energy (IE), which combines the change in velocity (Δv) and the principal direction of force. In this study, our objective was to evaluate the incidence and pattern of cervical spine injury (CSI) following falls, stratified by fall height. We hypothesized that the incidence of CSI would not correlate with fall height, as the vertical IE vector of a fall does not translate into the horizontal IE relevant to cervical spine motion.
METHODS: We queried the trauma registry at our level I trauma center for all patients admitted with fall-related injury between 2013 and 2018. CSI was identified using International Classification of Diseases, Ninth Revision, codes 805, 806, 839, or 952. For eligible patients, we extracted clinical and radiographic data from registry and inpatient chart review. A single author (N.K) reviewed computed tomography scans of patients with CSI to confirm the diagnosis. We classified patients into 3 fall-height groups: ground-level fall (GLF); low fall (LF), <20 feet; and high fall (HF), ≥20 feet. We also classified CSI anatomically into an upper (C1-C3) and lower (C4-C7) injuries. Descriptive summary statistics were performed, and a regression model was used to identify independent risk factors for CSI. A P value < 0.05 was considered statistically significant.
RESULTS: During the study period, 4759 patients suffered from a fall. This included 1571 GLF patients, 2518 LF patients, and 670 HF patients. The overall incidence of CSI was 4.9%, 8.9% among GLF patients, 2.5% among LF patients, and 4.3% among HF patients. Fall height was not a significant risk factor for CSI (odd ratio [OR], 0.59; 95% confidence interval [CI], 0.47-0.75. However, age (OR, 1.03; CI, 1.02-1.04) and male gender (OR, 1.7; CI, 1.3-2.3) were significant risk factors. Additionally, older patients more frequently sustained upper (C1-C3) CSI, whereas younger patients more commonly sustained lower (C4-C7) CSI.
CONCLUSIONS: The overall incidence of CSI after a fall was 4.9%. There was no correlation between fall height and the incidence of CSI. This finding may be explained by the mismatch between the vertical vector of fall-related IE and the horizontal direction of cervical spine motion. Future studies will continue to explore the incidence and injury pattern of CSI across other trauma mechanisms.
PMID:42430831 | DOI:10.1016/j.jss.2026.06.029
