Spinal injuries Facts and fiction

Trauma care puts considerable burden on the global healthcare system. Traumatic spinal injuries are relatively common and have the lowest functional outcomes and the lowest return-to-work rates after injury of all major traumas. Given these societal impacts, understanding the incidence, characteristics and healthcare demands of spinal injuries – and how these parameters develop over time – is crucial. The aim of this thesis was to determine the incidence of spinal injuries in the Netherlands, to evaluate the effectiveness of spinal immobilization procedures, and to document the diagnostic workup of spinal injuries in children. In terms of incidence, between 1997 and 2012, the number of patients with a spinal fracture in the Netherlands more than doubled, while the hospitalization rate and number of spinal cord injuries remained stable. Regarding the effectiveness of spinal immobilization, experts disagree about the need for immobilization for all patients with suspected spinal cord injuries, and high-level scientific evidence to support or reject immobilization is lacking. Although spinal immobilization is widely used to prevent spinal cord injury, it cannot be explained historically, and the potential dangers of spinal immobilization have been widely reported. Studies completed as part of this thesis suggest that many patients are immobilized unnecessarily. In children, while the guidelines for cervical spine imaging are clear, the use of computed tomography has increased significantly since its introduction, especially in the emergency department. This is concerning given the potential increase in lifetime cancer risk in children due to the radiation used in this type of imaging.