The present study’s results showed that about 60% of the subjects were male. The findings were consistent with other studies in which about 65 to 76 percent of the subjects were men (14–19). In the study conducted by Khanpara et al. (20), the number of men was twice that of women. Seemingly, since the prevalence of accidents is higher in men (21), injuries are more common in men than women.
The subjects’ mean age was 39.8 ± 15.3 years, and most of the patients were in the age range of 25 to 44 years. In Griffin et al.’s study (22), the mean age of patients was 39.4 years; in Singh et al.’s study (14), the mean age was 38 years; in Sabzeghabaei et al.’s research (16), the mean age was 32 years, in Saadat et al.’s study (17), it was 36 years, and in Asadi et al.’s study (19), they had a mean age of 39 years. Also, the highest age range involved was 30 to 59 years. In the study carried out by Khanpara et al., the most common age group with cervical spine injury was 21–30 years, and the second most common age group was 31–40 years (20). As shown in the study of Goldberg et al. (6), injuries were more common in the third decade of life. In a study conducted in Japan, the median age of patients was 59 years (4). The findings are also consistent with the results of other studies. This demographic pattern can be attributed to the youth group’s high-risk behaviors and can increase burden since it affects more years of a person’s life.
The most common mechanisms of injury leading to cervical spine trauma were traffic accidents and vehicle (car) accidents. The mechanisms are similar to previous studies in Iran (16, 17, 19, 23, 24) and other country (14, 20, 25–27). In the Japanese study, the mechanisms of injury were ground-level fall (40.9%), falling from stairs (18.7%), and motor vehicles (10%), respectively (4). Due to the rapid increase in the mechanization of communities in different parts of the world, traffic injuries are the most important causes of trauma.
Based on the present study results, the cervical X-ray’s sensitivity and specificity were 55.56 and 97.17%, respectively. The current study results are consistent with Singh et al.’s study (14), and the sensitivity and specificity of cervical spine radiography compared to CT scan in Singh’s research were calculated as 69.23 and 97.3%, respectively. In the study conducted by Sabzehghabaei et al. (16) in hospitals under the supervision of Shahid Beheshti University of Medical Sciences in Tehran, sensitivity was 33.09, and specificity was 80.48%. In the study of Platzer et al. in Austria (28), the cervical X-ray had a sensitivity of 63%, and in another study by Widder et al. in Canada, the sensitivity of plain radiography was 39 and 98%, respectively (12). In Diaz et al.’s study, the radiography’s sensitivity and negative predictive value were reported to be 16% and 74%, respectively. The results also showed that plain radiography was unsuccessful in identifying 72% (294.416) of the fractures detected by CT scans (29). A study carried out by Griffin et al. in California reveals that the damage could not be observed in the radiography images of 3.2% (41 patients) of patients while they could be diagnosed by the CT scans instead. Griffin’s study discovered that using a CT scan to evaluate the cervical spine is more appropriate than a cervical X-ray (22). Besides, Nunez et al. indicated that injuries to the cervical vertebrae that were not detected by the cervical X-ray could be correctly diagnosed by the CT scan (30). A review study concluded that plain radiography has low sensitivity in identifying cervical spine injuries, especially in transitional regions (31). The results of Ramouz et al.’s study showed higher sensitivity and specificity of the CT scan in the diagnosis of traumatic neck injuries (32). In another review study conducted by Hollingworth et al., the results of reviewing various studies showed that the sensitivity and specificity of the CT scan in the diagnosis of cervical vertebrae trauma lesions are between 70–90% (33). Furthermore, in the review study of Aboziad et al., the results of reviewing different studies showed that the CT scan is the main option for examining all spinal cord injuries, and its sensitivity for cervical spine lesions and any unstable lesion is 87.5% and 100%, respectively (31).
Besides, the positive and negative predictive values of the plain radiographies were 62.50% and 96.26%, respectively. In a study conducted in Tehran hospitals (16), the positive predictive value was 85.18%, and the negative predictive value was 26.16%. In a study conducted in India, positive and negative predictive values were calculated to be 90% and 10%, respectively (14). In the current study, healthy radiographs were reported in four patients, while fractures were seen on CT scans. In Singh et al.’s study, out of 50 patients studied, the radiograph did not show the damage in four cases, but in the CT scan images, the presence of damage was confirmed (14).
The results indicated that the accuracy of plain radiography compared to CT scan in diagnosing traumatic lesions is very low, which is due to the very low sensitivity of plain radiography in diagnosing fractures and dislocations of the neck. Therefore, it seems that cervical X-rays cannot be a useful tool to rule out cervical spine injuries following head and neck trauma.