AJNR Am J Neuroradiol. 2025 Aug 14. doi: 10.3174/ajnr.A8849. Online ahead of print.
ABSTRACT
BACKGROUND AND PURPOSE: Upper cervical spine trauma (UCST) can lead to severe morbidity and mortality, particularly when associated with craniocervical junction (CCJ) injuries. Previous studies suggest that identifying prevertebral hematomas in patients with cervical trauma may have clinical significance. However, the association between prevertebral hematomas and clinical outcomes in patients with UCST has not yet been firmly established. The purpose of this study is to investigate the association of prevertebral hematomas with the severity of upper cervical spine injury, and clinical outcomes in patients with UCST.
MATERIALS AND METHODS: This retrospective study analyzed patients with UCST admitted to a level I trauma center in a 3-year period. Inclusion criteria included cervical spine trauma confirmed via imaging and MRI performed within 7 days of admission. Prevertebral hematomas were assessed for size and location and correlated with injury patterns and clinical outcomes. Statistical analysis was performed by using χ2 tests and logistic regression models.
RESULTS: One hundred sixty-five patients (mean age, 40.6 ± 19.9 years; 103 men) were evaluated. Prevertebral hematomas were identified in 88 of 165 patients (53.3%). Hematomas were significantly associated with CCJ dislocations (17/23 patients; 73.9%, P = .03) and subaxial disco-ligamentous injuries (48/71 patients; 67.6%, P = .001). Surgical intervention was more likely in patients with prevertebral hematomas (39/60 patients; 65%, P = .02), with an OR of 2.08 (95% CI, 1.08-4.01). While 75 of 148 patients with neurologic disability at discharge had prevertebral hematomas (50.6%, P = .06), this association did not reach statistical significance.
CONCLUSIONS: Prevertebral hematomas were significantly associated with CCJ dislocations, subaxial disco-ligamentous injuries, and an increased likelihood of surgical intervention in patients with UCST. These findings suggest that prevertebral hematomas can serve as a useful marker for identifying patients with more severe injury patterns.
PMID:40813212 | DOI:10.3174/ajnr.A8849
