Spine Journal - 2026-09-11 - Journal Article
Incidental Cervical Spine Stenosis by Race and Ethnicity Among Trauma Patients: A Retrospective Cross-sectional Clinical Study.
Kindo B, Welch J, Zurita D, Rumley J, Gemmel D, Ugokwe KT
Topics
Key Takeaway
Incidental cervical stenosis prevalence at C3-C4 was 21.4% in Black patients versus 15.4% in White patients among 381 trauma patients with unremarkable cervical CT scans.
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Summary
This study examined racial differences in incidental cervical stenosis prevalence using CT measurements (SCD <13 mm, IPD <23 mm per Bajwa criteria) in trauma patients with unremarkable cervical CTs at a single Level 1 center from 2013–2023. Black patients had a 21.4% stenosis prevalence at C3-C4 versus 15.4% in White patients, with C3-C4 identified as the most commonly affected level. Asian and American Indian groups (n=5 combined) showed no levels meeting stenosis criteria, though sample sizes preclude any inference.
Key Limitation
The single-center convenience sample with extreme racial imbalance (81% White, 19% Black) and absence of statistical testing between racial groups prevents generalization of the observed prevalence differences.
Original Abstract
BACKGROUND
Congenital cervical spine stenosis is an anatomical narrowing of the cervical spine canal, an aberrant anatomy, which can predispose patients to a wide variety of spinal injuries in undiagnosed individuals, even in the setting of minor trauma. Life-threatening injuries with premature career endings are not uncommon among athletes with undiagnosed congenital cervical stenosis sustaining cervical trauma and are well reported in many news outlets. Unfortunately, no clear consensus regarding diagnostic workup and universal guidelines regarding return to play exist. A similar imbroglio exists over criteria and parameters used to screen and diagnose the condition, as well as the demographics and epidemiology of congenital cervical spine stenosis due to limited evidence.
PURPOSE
The goal of this retrospective study is to investigate the prevalence of congenital cervical spine stenosis by race.
STUDY DESIGN
Large level 1 trauma center retrospective cross-sectional study
PATIENT SAMPLE
A total of 381 trauma patients with unremarkable cervical spine CAT scan from 01/01/2013-12/31/2023
OUTCOME MEASURES
The mid-sagittal canal diameter (SCD) and the interpedicular distance (IPD) were measured from C3-T1 using criteria established by Bajwa, SCD < 13 mm and IPD < 23 mm as cut points for cervical spine stenosis, with sensitivity and specificity of 88-100% at each cervical vertebral body.
METHODS
A total of 797 patients were reported in the registry; 416 met exclusion criteria. ßDemographic variables, such as age, gender and race, were collected. All patients with a history of cervical spine injury, previous surgeries, and pre-existing anomalies, including lesions, mass, deformity and technical artifact, were excluded. The mid-sagittal canal diameter (SCD) and the interpedicular distance (IPD) were measured from C3-T1.
RESULTS
Three hundred and eighty-one (381) patients met inclusion criteria: 306 (81%) were White, 70 (19%) were Black, 3 (0.78) identified as Asian, and 2 (0.52) were American Indian. In the Asian and American Indian groups no cervical level met the criteria of stenosis as defined by an SCD <13 mm and IPD <23 mm. For both the White and Black participant groups, C3-C4 was found to have the narrowest canal diameter with an average SCD of 13.57 ± 1.63and IPD 21.83 ± 1.53. The White participant group prevalence was 15.4% at C3-C4, compared to 21.4% among the Black participant group.
CONCLUSION
This study revealed a high prevalence of congenital cervical stenosis within a trauma population with a higher prevalence within the Black participant group. Additionally, C3-C4 was found the most commonly affected level, as opposed to previous reports at C5. Providers must remain vigilant for stenosis in at-risk populations.