Diagnostic yield and number needed to screen for cervical and concomitant spinal injuries in geriatric head trauma.

INTRODUCTION: Geriatric patients with head trauma face an increased risk of cervical spine injuries (CSI) and concomitant spinal injuries (CoSI). The added value of cervical spine MRI (csMRI) and whole-spine imaging alongside routine cranial CT (cCT) and cervical spine CT remains unclear. RESEARCH QUESTION: This study evaluates the prevalence and risk factors for CSI, the number needed to screen (NNS) to detect CoSI and the diagnostic yield of csMRI. MATERIALS AND METHODS: Patients aged ≥65 years presenting after head trauma to a Level I trauma center between January 2020 and October 2025, undergoing cCT and cervical spine CT, were analyzed. RESULTS: A total of 2748 geriatric patients were included, with 63.9% aged ≥80 years and 1.5% showing sensomotoric deficits. CSI occurred in 6.0%, equally affecting axial and subaxial regions. Conservative treatment of CSI was employed in 75.2%, while dorsal instrumentation was the most performed operative technique (63.4%). Risk factors for CSI included advanced age (OR = 1.1, p = 0.03), ankylosing spinal disease (OR = 5.9, p < 0.001) and thoracic trauma (OR = 2.9, p < 0.001). The NNS for incremental yield of csMRI was 54.9 for patients aged ≥65 years and 45.3 for those aged ≥80 years. For CoSI the NNS were 29.4 and 19.3 respectively. Among patients undergoing additional csMRI, subaxial injuries were observed in 45.6%, with 70.0% being treated conservatively. DISCUSSION AND CONCLUSION: CSI are common in geriatric head trauma and frequently accompanied by CoSI. Given the low NNS, a liberal use of extended imaging, including whole-spine CT and selective csMRI, can be considered to improve patient safety. LEVEL OF EVIDENCE: III, survey.