European Spine Journal - 2026-03-07 - Journal Article
Cervical spine fracture patterns associated with blunt cerebrovascular injuries: A literature review and meta-analysis.
Kristensen L, Jeppesen HSF, Brink O, Høy K
Topics
Key Takeaway
Transverse foramen fractures (OR 3.42) and subluxation/dislocations (OR 4.41) are the cervical fracture patterns most strongly associated with blunt cerebrovascular injury, while isolated level-based fractures (C1, C2, C1-C3, C4-C7) show no statistically significant association.
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Summary
This PRISMA-compliant meta-analysis of English-language literature (2000–2026) examined whether specific cervical fracture patterns predict blunt cerebrovascular injury (BCVI) to improve screening criteria. Seven studies from 717 screened met inclusion criteria; random-effects pooled ORs were calculated for isolated C1, C2, C1-C3, C4-C7, transverse foramen, subluxation/dislocation, and two-level fractures. Only transverse foramen fractures (OR 3.42, 95% CI 1.61–7.26) and subluxation/dislocations (OR 4.41, 95% CI 2.88–6.76) reached statistical significance for BCVI association.
Key Limitation
Only 7 heterogeneous studies met inclusion criteria, and significant I² values required leave-one-out analysis, meaning the pooled estimates—particularly for upper cervical fractures—are insufficiently powered to rule out clinically meaningful associations.
Original Abstract
PURPOSE
Cervical spine fractures (CSF) have been linked to blunt cerebrovascular injuries (BCVI) due to arterial proximity, but consensus on screening criteria remains elusive. This literature review hypothesises that BCVI rates differ with CSF types and aims to identify predictive CSF patterns for BCVI, enhancing screening accuracy and diagnostics.
METHODS
All English literature (2000-2026) was reviewed according to PRISMA guidelines in PubMed and Embase. Inclusion criteria were adults (> 16 years), blunt cervical trauma, and specific CSF patterns associated with BCVI. Exclusion criteria were pediatric patients, penetrating traumas, and no accessible full text. A random-effects meta-analysis was conducted to produce pooled odds ratios with a corresponding 95% confidence interval for each specific fracture pattern. I2-statistics were calculated to assess the proportion of variation attributed to heterogeneity and whether that variation was significant. Leave-one-out analysis was conducted on estimates with significant heterogeneity Calculations were made using Stata18.
RESULTS
Among 717 eligible articles, 7 studies met the criteria. Specific CSF patterns mentioned were isolated C1 and C2 fractures, any C1-C3 and C4-C7 fractures, two-level fractures, subluxation/dislocations, and transverse foramen (TF) fractures. Pooled odds ratio with 95% confidence interval for BCVI and C1 fractures was: 1.38 (0.97-1.94); C2: 1.18 (0.88-1.58); C1-C3: 1.89 (0.99-3.60); C4-C7: 0.98 (0.61-1.59); TF: 3.42 (1.61-7.26); Subluxation/dislocations: 4.41 (2.88-6.76); Two-level: 1.19 (0.78-1.82).
CONCLUSION
This meta-analysis showed an association between facet dislocations and fractures involving the transverse foramen and increased odds of BCVI. No statistically significant association was identified between BCVI and fractures at specific vertebral levels, although upper cervical fractures were frequently observed among affected patients. Heterogeneity between studies calls for caution when interpreting results.