Bicycle-related cervical spine injuries

N Am Spine Soc J. 2022 Apr 30:10:100119. doi: 10.1016/j.xnsj.2022.100119. eCollection 2022 Jun.


Background: Bicyclists are vulnerable road users. The aim of this paper was to describe all bicycle-related traumatic cervical spine injuries (CSIs) in the South-East region of Norway (2015-2019), and to investigate whether certain types of CSIs are typical for bicyclists.

Methods: Retrospective cohort study of prospectively collected registry data of all CSIs in the South-East region of Norway (3.0 million inhabitants), from 2015 to 2019. Patient characteristics, injury types, and treatment were summarized with descriptive statistics. Bayesian multivariable logistic regression was used to identify potential factors associated with occipital condyle fractures (OC-Fx) or odontoid fractures (OFx).

Results: During the five-year study period, 2,162 patients with CSIs were registered, and 261 (12%) were bicycle-related. The incidence of bicycle-related CSIs was 1.7/100,000 person-years. The median age of the patients with bicycle-related CSIs was 55 (IQR: 22) years, 83% were male, 71% used a helmet, 16% were influenced by ethanol, 12% had a concomitant cervical spinal cord injury (SCI), and 64% sustained multiple traumas. The three most common bicycle-related CSIs were C6/C7 fracture (Fx) (28%), occipital condyle Fx (OC-Fx) (23%) and C5/C6 Fx (19%). Patients with bicycle-related CSIs compared to patients with non-bicycle related CSIs were younger, more often male, had fewer comorbidities, more likely multiple traumas, more often had OC-Fx, and less often sustained an odontoid fracture (OFx). Multivariable logistic regression of potential risk factors for OC-Fx demonstrated a significantly increased risk of OC-Fx for bicyclists compared to non-bicyclists (OR=2.8).The primary treatment for bicycle-related CSIs was external immobilization in 187/261 (71.6%) cases, open surgical fixation in 44/261 (16.8%), and no treatment in 30/261 (11.5%).

Conclusion: Bicycle crashes are a frequent cause of CSIs in the Norwegian population and should be of concern to the public society. The three most common bicycle-related CSIs were C6/C7 fracture, occipital condyle fracture and C5/C6 fracture.

Keywords: ASA-PS, American Society of Anesthesiologists physical status; Bicycling; CSI, Cervical spine injury; Fx, Fracture; GCS, Glasgow coma scale; Multiple trauma was defined as a simultaneous TBI (mild, moderate, or severe according to HISS) and/or imaging-proven (X-ray, CT, or ultrasound) injury in one or more of the following regions: face, thoracolumbar spine, chest, abdomen, pelvis or extremities. Skin injuries were not registered; OC-Fx, Occipital condyle fracture; OFx, Odontoid fracture; OUH-U, Oslo University Hospital, Ullevål; Occipital condyle fracture; Public health; Spine; Surgery; TBI, Traumatic brain injury; Trauma; cSCI, Cervical spinal cord injury.