Selection of Trauma Victims for Cervical Spine Radiological Examination

1985 ◽  
Vol 1 (S1) ◽  
pp. 199-202
Author(s):  
Betty L. Bryson ◽  
Joseph P. Ornato ◽  
Robert R. Farquharson ◽  
Patrick J. Donovan ◽  
Francis G. Palaio
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Medical Center ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Facial Trauma ◽  
X Rays ◽  
Facial Soft Tissue ◽  
Cervical Spine Injuries ◽  
Facial Injuries

Evaluation of the traumatized patient frequently involves consideration of possible cervical spine injury. When neurological deficits, unconsciousness, alcoholic intoxication, severe maxillofacial or head trauma, or local neck pain are present, it is an easy decision to obtain cervical spine x-rays. The dilemma arises in the patient without neck pain who has mild to moderate scalp or facial injuries. Such a patient usually arrives in the emergency department with a cervical collar placed by pre-hospital personnel because of the mechanism of injury and the associated head or facial soft tissue trauma. Due to the association of cervical spine fractures with “significant” facial trauma, neck x-rays have been recommended. What, however, constitutes “significant” facial trauma To delineate such facial injuries, a retrospective analysis of 30 patients with cervicalspine fractures hospitalizedin a five year period at the University of Nebraska Medical Center was performed. Seventeen patients had head, scalp or facial injuries ranging from skull fractures and scalp hematomas to minor abrasions and lacerations. To determine if cervical spine films are being over utilized, a current prospective study of patients undergoing this evaluation will be presented, detailing the facial and head injuries, location, degree of severity, and detection of cervical spine injuries.

scholarly journals Traumatic cervical spine injury: Short-and medium-term prognostic factors in 102 patients

2020 ◽  
Vol 11 ◽  
pp. 19
Author(s):  
Hilal Abboud ◽  
Idris Ziani ◽  
Adyl Melhaoui ◽  
Yasser Arkha ◽  
Abdessamad Elouahabi
Keyword(s):  
Risk Factors ◽  
Prognostic Factors ◽  
Cervical Spine ◽  
Significant Risk ◽  
Neurological Deficits ◽  
Spine Injury ◽  
Medium Term ◽  
Cervical Spine Injuries ◽  
Active Population ◽  
Poor Outcomes

Background: Traumatic cervical spine injuries (CSIs) can be defined as osteodiscoligamentous lesions and are frequent in the young and active population. These lesions are often associated with significant devastating neurological deficits. Here, we sought to establish short-and medium-term prognostic factors that could help predict future outcomes. Methods: We retrospectively reviewed 102 adults admitted for traumatic CSI over an 11-year period (January 2004–December 2014). Patients were graded using Frankel scale as exhibiting good or poor outcomes. Results: Two risk factors that significantly predicted results for CSI included original poor Frankel grades (e.g., A and B) and initial neurovegetative disorders (e.g., respectively, P = 0.019 and P = 0.001). However, we did not anticipate that two other risk factors, operative delay and mechanism of trauma, would not significantly adversely impact outcomes. Conclusion: Here, we identified two significant risk factors for predicting poor outcomes following CSI; poor initial Frankel Grades A and B and neurovegetative disorders at the time of original presentation.

scholarly journals Treatment strategies for managing cervical spine injuries in rugby players

2021 ◽  
Vol 12 ◽  
pp. 6
Author(s):  
Ratko Yurac ◽  
Juan Jose Zamorano ◽  
Guisela Quinteros ◽  
Guillermo Izquierdo ◽  
Felipe Novoa ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Treatment Strategies ◽  
Neurological Deficits ◽  
Cervical Spine Fracture ◽  
Spine Fractures ◽  
X Rays ◽  
Cervical Spine Injuries ◽  
Cervical Spine Fractures ◽  
Rugby Players ◽  
Ct Studies

Background: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. Methods: Seven patients sustained cervical spine fracture attributed to rugby (2009–2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). Results: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. Conclusion: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.

Halo vest versus spinal fusion for cervical injury: evidence from an outcome study

1989 ◽  
Vol 70 (6) ◽  
pp. 884-892 ◽  
Author(s):  
Richard D. Bucholz ◽  
K. Charles Cheung
Keyword(s):  
Cervical Spine ◽  
Medical Center ◽  
Spine Injury ◽  
Cervical Injury ◽  
Halo Vest ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Surgical Fusion ◽  
Spine Injuries ◽  
Halo Device

✓ The indications for surgical fusion, as opposed to halo fixation, in the management of cervical spine injury are still unclear. At St. Louis University Medical Center a conservative protocol has been adopted to treat almost all cervical spine fractures with halo fixation. To determine what factors have contributed to failure of halo fixation, the records and radiographs of all patients with cervical spine injuries who were treated at that institution between 1984 and 1986 were reviewed. During this interval, 124 patients were treated, consisting of 93 men and 31 women between 6 and 94 years old. Of these, 15 (12%) had cervical fusion without preoperative halo device application. This group included eight patients with old injuries and delayed diagnosis, three with nonreducible locked facets, and four with miscellaneous indications. The remaining 109 patients were treated with halo vests. Four died before completing the 3-month standard treatment. Of those completing the treatment, 48 had C1–2 level injuries and 57 had C3–T1 level injuries. Sixteen patients (15%) failed their halo treatments and required surgical fusion: eight while still in halo fixation and eight after they had completed treatment with a halo device. Failure of halo treatment was indicated by recurrent dislocation in 13 patients and increased neurological deficit in three. Thirteen of the patients who failed treatment had C3–T1 injuries and three had C1–2 injuries. Of 27 patients with odontoid fractures, only two (7.4%) failed halo fixation. There were no failures in 11 patients with hangman's fractures. Of the 57 patients with C3–T1 injuries, 13 (23%) failed treatment, nine of whom had locked or “perched” facets. The factors causing failure of halo fixation were analyzed. The overall success rate was 85%, suggesting that the halo vest can be used to treat most patients with cervical spine injuries. Under certain circumstances (in the presence of old injuries, difficult reduction, or locked or “perched” facets), surgery may be indicated to avoid unnecessary delay in definitive management.

scholarly journals Epidemiological study of cervical spine injury in a tertiary care center in South India

2020 ◽  
Vol 7 (9) ◽  
pp. 2895
Author(s):  
Prasanth Asher ◽  
Jijo Joseph Joseph ◽  
Varun Singh Pendro ◽  
Anilkumar Peethambaran ◽  
Rajmohan Bhanu Prabhakar
Keyword(s):  
Cervical Spine ◽  
Neck Pain ◽  
Cervical Spine Injury ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Spine Injury ◽  
Mechanism Of Injury ◽  
Road Traffic Accidents ◽  
Cervical Spine Injuries ◽  
Spine Injuries

Background: Cervical spine injuries, according to severity can leave victims with long standing neck pain or varying degrees of weaknesses. The purpose of this study is to determine the epidemiological pattern of cervical spine injury in our hospital so that comparison may be made with other institutions and guidance regarding management may be formulated for the betterment of patients.Methods: This cross-sectional longitudinal study was conducted in Government Medical College, Thiruvananthapuram and included all patients admitted with clinical or radiological evidence of cervical spine injury, over a period of three months.  Semi-structured questionnaire was used to collect socio demographic data and details regarding mechanism of injury. Data was analyzed using SPSS.Results: Out of 452 patients enrolled, 69.7% were males and 30.3% were females. Patients were the most commonly between 30-60 years of age (52.4%). Majority (56.1%) had hospital stays lasting less than 10 days. Most common mechanism of injury was road traffic accidents (46.6%). Neck pain was the most common symptom and cervical spine straightening was the most common radiological abnormality. The severity of injuries was more severe in patients who were not restrained by seat belt or using a helmet.Conclusion: Road traffic accidents are the most common cause for cervical spine injuries and majority of patients required only symptomatic care.

scholarly journals Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

CJEM ◽  
2014 ◽  
Vol 16 (02) ◽  
pp. 131-135 ◽  
Author(s):  
Hendrik P. Van Zyl ◽  
James Bilbey ◽  
Alan Vukusic ◽  
Todd Ring ◽  
Jennifer Oakes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Clinical Skills ◽  
Ct Scans ◽  
Spine Injury ◽  
Emergency Physicians ◽  
Cervical Spine Injuries ◽  
Spine Ct ◽  
Spine Injuries ◽  
Rule Out

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

Paramedic Documentation of Indicators for Cervical Spine Injury

1994 ◽  
Vol 9 (1) ◽  
pp. 40-43 ◽  
Author(s):  
Andre M. Pennardt ◽  
Wm. John Zehner
Keyword(s):  
Emergency Department ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Spinal Injury ◽  
Medical Center ◽  
Prehospital Care ◽  
Retrospective Chart Review ◽  
Spine Injury ◽  
Status Assessment

AbstractIntroduction:Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should “wear that collar and be strapped to that board.” Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport.Hypothesis:Algorithms exist for physicians to “clear” the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations.Methods:A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted.Results:All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR).Conclusion:Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.

Neck Injury

1995 ◽  
Vol 16 (1) ◽  
pp. 28-28
Author(s):  
Jeffrey R. Avner
Keyword(s):  
At Risk ◽  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Pediatric Patients ◽  
Neck Injury ◽  
Spine Injury ◽  
Clinical Markers ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Spine Radiographs

Although rare in pediatrics, cervical spine injuries still are associated with serious morbidity, disability, and mortality. Many of these injuries are exacerbated by inadequate neck immobilization or improper manipulation. Thus, the physician should be aware of which children are at risk for cervical spine injury and how to assess these patients properly. To find clinical markers that identify children who actually have cervical spine injuries, Rachesky et al reviewed 2133 cervical spine radiographs obtained in pediatric patients during a 7-year period. Of these children, 25 (1.2%) had abnormalities confirmed on radiographs. The incidence of injury increased with age; only four of the children who had cervical spine injuries were less than 8 years old.

What a Pain in the Neck!

2020 ◽  
pp. 13-22
Author(s):  
Walter Wiswell ◽  
Bryan McCarty
Keyword(s):  
Decision Making ◽  
Emergency Department ◽  
Cervical Spine ◽  
Neck Pain ◽  
Pediatric Patient ◽  
Ct Scans ◽  
X Rays ◽  
Pros And Cons ◽  
Current Guidelines ◽  
Patient Presentation

The chapter on cervical spine controversies in children describes what initial steps need to be taken in assessing a pediatric patient with neck pain after trauma, and discusses the decision-making process that goes into further evaluation and testing. Clinical actions and assessments of the patient on-scene, whether to pursue imaging once in the emergency department setting, and what imaging is most appropriate depending on the patient presentation are discussed. Indications and contraindications for cervical spine immobilization and spinal positioning, including proper techniques based on a patient’s age and whether or not such steps are necessary. It also discusses the pros and cons of x-rays, CT scans, and MRIs in the context of pediatric neck trauma, and current guidelines that should be followed when deciding to order such studies.

Cervical spine injuries

2019 ◽  
pp. 789-800
Author(s):  
Calan Mathieson ◽  
Chris Barrett ◽  
Likhith Alakandy
Keyword(s):  
Cervical Spine ◽  
Classification Systems ◽  
Neurological Injury ◽  
Spine Injury ◽  
Spine Fractures ◽  
Cervical Spine Injuries ◽  
Heterogenous Group ◽  
Spine Injuries ◽  
Spine Surgeon ◽  
Cervical Spine Fractures

The management of cervical spine fractures is a complex and fascinating topic. A multitude of descriptive terminologies and classification systems have been developed over the years in an attempt to better understand this heterogenous group of patients. Despite this however, there is often little consensus with regards to the best way to manage this population. This chapter will predominantly discuss the decision-making process involved in the management of cervical spine fractures. The goal of the spine surgeon in managing patients with acute cervical spine injury is to prevent secondary neurological injury, deformity, and pain by re-establishing stability if necessary. Assessing how to achieve this goal can be very challenging. The surgeon will be faced with many questions. Which patients should undergo surgical intervention? Which operation will best stabilize the spine? Which patients should be treated with a collar or a halo vest? Does the injury require reduction with traction initially? There are also questions of timing. When should the surgeon plan the proposed procedure?

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