Clinical and radiological factors associated with mortality following acute cervical spine injury: A retrospective analysis of Bhutan’s National Spine Registry.

Abstract

Introduction: Cervical spine injuries are associated with high mortality and long-term disability. Data on factors influencing treatment outcomes and mortality in Bhutan remain limited. This study aimed to identify proportion and the factors associated with mortality among patients with acute cervical spine injury. Methods: Retrospective review of the National Spine Registry (NSR) maintained at Jigme Dorji Wangchuck National Referral Hospital was conducted from January 2023 to December 2025. Adult patients with acute cervical spine injury who completed one year of follow-up were included. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 26.0. Results: A total of 320 patients with spinal injuries were recorded during the year 2023 to 2025, of which, 24.3% (n=78) patients sustained acute cervical spine injury and 60 patients fulfilled the inclusion criteria. The majority were male (83.3%, n=50), road traffic accidents were the most common mechanism of injury (53.3%, n=32). Complete cord injury (ASIA A) was present in 30%, n=18) of patients. Operative management was performed in (66.7%, n=40) of cases. The overall mortality rate was (18.3%, n=11), with sepsis being the leading cause of death (63.6%). On univariate analysis, neurological status at presentation, presence of neurogenic shock, injury morphology, extent of cord edema, timing of surgery, timing of tracheostomy, and use of incentive spirometry were significantly associated with mortality (p < 0.05). Conclusion:Mortality following acute cervical spine injury remains substantial. Early surgical intervention and timely respiratory support, including intubation and tracheostomy in high-risk patients, may reduce mortality and improve outcomes.