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Purpose : To evaluate the incidence of secondary contiguous or non-contiguous subchondral bone impactions (SBI) insubaxial cervical spinal injury and associated primary injury patterns. Materials and Methods: A retrospective review of computed tomography, magnetic resonance imaging, and medicalrecords was carried out for 47 patients who had sustained a subaxial cervical spinal injury. Presence, number, level, andsites of secondary contiguous or non-contiguous SBI were recorded. To evaluate primary injury patterns, the level andnumber of primary injury sites of subaxial cervical spine injury, injury morphology, anterior/posterior discoligamentouscomplex (ADC/PDC) injury, posterior ligamentous complex (PLC) injury, spinal cord injury, and mechanism of injury (MOI)were analyzed. Differences in primary injury pattern of subaxial cervical spine injury and MOI between patients with andwithout SBI, and between contiguous or non-contiguous SBI were analyzed using the Mann-Whitney U test, Pearson’s chisquare test and Fisher’s exact test. Results: Eighteen patients (18/47, 38.29%) had developed contiguous (n=9) or non-contiguous (n=9) SBI, most commonlyinvolving T3 (15/47, 31.91%) and 3 levels (6/18, 33.33%). All SBIs had developed near the anterosuperior regionof the body and the superior endplate and were the result of a high-impact MOI. SBIs were statistically significant in associationwith injury morphology and PLC injury (P=0.001, P=0.009, respectively) at the primary injury site. Non-contiguousSBI was more frequently accompanied by upper cervical spinal injuries in association with PDC injuries, as opposed to contiguousSBI, with statistical significance (P=0.009), while no other statistically significant differences were found. Conclusion: Secondary SBIs are common and probably associated with subaxial cervical spinal injuries with high energycompressive flexion forces.

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