• G Canzi, E De Ponti, A Spota, G Mangini, E De Simone, S P B Cioffi, M Altomare, R Bini, F Virdis, S Cimbanassi, O Chiara, D Sozzi, and G Novelli.
• Maxillofacial Surgery Unit, Department of Neuroscience - Head & Neck, ASST GOM Niguarda, Milan, Italy.
• Eur Spine J. 2024 Jan 1; 33 (1): 198204198-204.

PurposeThis study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma.MethodsWe did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries.ResultsWe included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004).ConclusionsFacial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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