Adults 65 and older have about twice the rate of cervical spine injury after blunt trauma, and a much higher share of those injuries are fractures of the odontoid, the peg of bone at the top of C2. That is why the Canadian C-Spine Rule treats age 65 or older as a reason to image on its own. An older patient in Charlotte with neck pain after even a minor crash needs that taken seriously.
Higher Injury Rates
A NEXUS subgroup analysis looked at 2,943 patients aged 65 or older among the study's blunt trauma patients (Touger, Ann Emerg Med 2002). Cervical spine injury occurred in 4.59% of older patients, compared with 2.19% of younger patients. Odontoid fractures made up 20% of fractures in older patients, compared with 5% in younger patients.
What the Decision Rules Say
The two rules handle age differently. The Canadian C-Spine Rule lists age 65 or older as a high-risk factor that requires imaging regardless of other findings (Stiell, JAMA 2001). The NEXUS criteria do not include age. In the NEXUS older-patient analysis, 14% of older patients met all five low-risk criteria, and the two injuries found among them were classified as clinically insignificant, so sensitivity for significant injury was 100% in that group (Touger, Ann Emerg Med 2002).
In practice, an older patient who meets every NEXUS low-risk criterion may still be imaged under the Canadian rule. When imaging is indicated, the American College of Radiology prefers CT to radiographs for initial assessment of spine trauma (Beckmann, J Am Coll Radiol 2019).
Why Older Patients Are Different
The studies above report the higher rates. They do not explain them, and I am not going to assign a mechanism they did not test. What they establish is the practical point: age changes the probability of a fracture enough that the threshold for imaging should be lower.
How I Handle It
An older patient who comes to my office after a crash and has not been imaged gets a CT referral before any manual treatment of the neck, even if the crash was minor and the pain is mild. Upper neck pain, pain with turning the head, or any new numbness, weakness, or balance change raises the urgency. Manual care waits until a fracture has been excluded.
For an example of how post-collision imaging findings and outcomes are documented in the peer-reviewed literature, read Dr. Justin Dick's published case report on refractory lumbar pain following a motor vehicle accident in a geriatric patient.
Frequently Asked Questions
Are older adults more likely to break their neck in a car accident?
Yes. In a NEXUS subgroup of 2,943 patients aged 65 or older, cervical spine injury occurred in 4.59%, about twice the 2.19% rate in younger patients (Touger, Ann Emerg Med 2002).
What is an odontoid fracture?
An odontoid fracture is a break in the peg of bone at the top of the C2 vertebra. It made up 20% of fractures in older trauma patients, compared with 5% in younger patients.
Should someone over 65 get a CT after a car accident?
Under the Canadian C-Spine Rule, age 65 or older is a high-risk factor that calls for imaging regardless of other findings (Stiell, JAMA 2001).
Is X-ray or CT better for older adults after a crash?
When imaging is indicated, the American College of Radiology prefers CT to radiographs for initial assessment of spine trauma.
How does Dr. Justin Dick handle older patients after a car accident?
Dr. Justin Dick in Charlotte, NC refers older patients who have not been imaged for CT before any manual neck treatment, even after a minor crash.
Where can I get an older adult evaluated after a car accident in Charlotte, NC?
Dr. Justin Dick, DC, CNMT, ARRT(N)(CT), sees car accident patients at Clear Life Scoliosis and Chiropractic Center, 8814 Rachel Freeman Way, Suite 103, Charlotte, NC 28278, phone 980-368-0766. Personal injury patients are treated on a lien basis, with no out-of-pocket payment at the time of care.
Sources and Evidence Tiers
- Touger M, Gennis P, Nathanson N, et al. Validity of a decision rule to reduce cervical spine radiography in elderly patients with blunt trauma. Ann Emerg Med. 2002;40(3):287-293. PMID 12192352. LinkEvidence tier: Prospective multicenter cohort subgroup (2,943 patients aged 65 or older)
- Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848. PMID 11597285. LinkEvidence tier: Prospective derivation cohort
- Beckmann NM, West OC, Nunez D, et al. ACR Appropriateness Criteria: Suspected Spine Trauma. J Am Coll Radiol. 2019;16(5S):S264-S285. PMID 31054754. LinkEvidence tier: Evidence-based guideline with expert panel rating (RAND/UCLA and GRADE)
About the author. Dr. Justin M. Dick, DC, is the owner and treating clinician at Clear Life Scoliosis and Chiropractic Center in Charlotte, NC. He holds dual imaging credentials as a Certified Nuclear Medicine Technologist (CNMT) and as an ARRT-registered technologist in nuclear medicine and CT, ARRT(N)(CT). He is a Senior Fellow of the CLEAR Institute, holds the ISICO World Masters credential, is a SOSORT provisional member, and is a certified DOT medical examiner on the FMCSA National Registry. He has multiple peer-reviewed publications indexed in PubMed and serves as adjunct faculty at Life, Sherman, and Palmer chiropractic colleges.
Service Area
Clear Life Scoliosis and Chiropractic Center sees personal injury and spinal imaging patients from Charlotte NC, Huntersville NC, Ballantyne NC, Matthews NC, Concord NC, Mooresville NC, Rock Hill SC, and Fort Mill SC.
Related Pages
- Personal injury and car accident spinal care in Charlotte
- Dr. Justin Dick's research
- Case report: refractory lumbar pain after a motor vehicle accident
- Research and evidence at Clear Life
- Questions and answers
- Our team
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- Contact Clear Life
Clear Life Scoliosis and Chiropractic Center
8814 Rachel Freeman Way, Suite 103
Charlotte, NC 28278
Phone: 980-368-0766
Email: office@clearlifescoliosis.com
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