Women Are More Susceptible to Traumatic Lumbar Spine Injury Than Men

Peer Reviewed

Gender differences in traumatic spine injuries include a higher rate of cervical spine fractures in men and a higher rate of thoracolumbar fractures in women, according to a retrospective study published in the July issue of the Journal of Women’s Health. The mechanism of injury also differed with women being more susceptible to falls from the standing position (such as occurs in osteoporotic older women) and men being more likely to be in motorcycle accidents or falls from height.

While gender difference in spinal mechanisms are well known, new findings show the implications of these differences on the distribution of injuries, said lead author Eliezer Sidon, MD, a senior physician in the Department of Orthopedics at Rabin Medical Center, Petah-Tikva, Israel.
Woman falling on winter snow.A cause of spinal injury in women is falling from the standing position.Epidemiologic Data Collected From Trauma Center
Dr. Sidon and colleagues evaluated data from all patients with traumatic spinal injury treated at a single medical center between 2006 and 2010. Of the 546 patients included in this study, 168 were female (30.6%) and 378 were male (69.4%). The average age of women at the time of injury was significantly older than that in men (49.6 and 40.1, respectively; P<0.001).

A majority of patients (68%) were injured in a motor vehicle collision or a fall from the standing position or from height. Men were significantly more likely to be injured in a motorcycle collision (42 vs 6; P=0.003) or fall from height (118 vs 31; P=0.0018), while women were more likely to fall from the standing position (56 vs 36; P=0.0001). In the few women injured from a high fall, the injuries were linked to a suicide attempt.

No gender differences were found in the type of spinal damage resulting from traumatic injury, with the vast majority of patients (93%) suffering from fractures.

Why Are Women More Susceptible to Lumbar Spine Injury Than Men?
“Mobility, flexibility, and range of motion between segments of the spine may have a factor in the severity of injuries in high-energy injuries,” Dr. Sidon said.

“The structure of the lumbar spine is more curved and the cervical spine is more flexible in women,” Dr. Sidon told SpineUniverse. This difference makes the lumbothoracic spine susceptible to fracture and dislocation in women more than the lumbothoracic spine of men, and vice-versa for the cervical spine, where women have more flexibility,” he said. This flexibility in the cervical spine protects women from injury in this area, according to the researchers’ theory.

“In women, the lumbar spine is designed to support the uterus during pregnancy,” Dr. Sidon said. “Thus, it has a greater curve and different orientation of the joints between each vertebra compared with men, making the lumbar spine in women more stable and less mobile. Less mobility between adjacent vertebrae causes the lumbar spine to be susceptible to fractures during extreme injury mechanisms like motor vehicle accidents and fall from height.”

“In the cervical spine, on the other hand, women show increased range of motion compared with men, with smaller diameter of neck muscles and lower content of collagen fiber in the neck ligaments,” Dr. Sidon explained. “This makes the cervical spine of women more flexible and may be the factor protecting the cervical spine from fractures compared to the cervical spine of men.”

Trauma center surgeons may consider these gender differences when attending to patients with suspected spinal injury, the researchers wrote.

Clinical Implications
“This study represents and puts forth new information on why there are gender differences in patients with spinal injuries,” commented Jeffrey C. Wang, MD, who is not affiliated with the study. Dr. Wang is Chief of Orthopaedic Spine Service, Professor of Orthopaedic Surgery and Neurosurgery, and Co-Director of the USC Spine Center in Los Angeles.

“The study is important, as it offers demographic information on the rate of spinal injuries among male and female patients,” stated Dr. Wang. This data allows one to understand patients at increased risk for spinal injury, and for the types injuries that may occur among men and women. In turn, this information allows the clinician to perhaps better anticipate the types of spinal injuries according to the patient’s gender, which may better guide treatment.

“However, this research also provides new information on the anatomical differences between males and females, which may give us a better understanding of the injury mechanism and perhaps may lead to better prevention of these injuries,” Dr. Wang said. “The theories put forth by the authors discuss the possible mechanisms by which females sustain different types of injury patterns, and ground these theories in the physical differences in the anatomies between the two genders. However, the findings also give insight into mental or psychological issues that may differ between the two genders, which could be rooted in behavioral differences.”

While this study opens up discussion on this topic, “clearly more research is needed before we draw absolute conclusions,” Dr. Wang concluded.

Disclosures
Dr. Sidon has no relevant disclosures.
Dr. Wang’s disclosures.

Updated on: 09/20/18
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Eliezer Sidon, MD
Senior Physician
Department of Orthopedics
Rabin Medical Center, Israel
Jeffrey C. Wang, MD
Chief of Orthopaedic Spine Service
Keck Medical Center of USC Professor, Orthopaedic Surgery and Neurosurgery
Keck School of Medicine at USC Co-Director of the USC Spine Center
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