Cervical spine injuries

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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20 Cervical Spine Fragility Fractures in Older People: 5-Year Experience At A Regional Spine Centre

Age and Ageing ◽

10.1093/ageing/afz183.20 ◽

2020 ◽

Vol 49 (Supplement_1) ◽

pp. i1-i8

Author(s):

A M Tarawneh ◽

S Taqvi ◽

K M I Salem ◽

O Sahota

Keyword(s):

Cervical Spine ◽

Older People ◽

High Energy ◽

Low Energy ◽

Spine Fractures ◽

Axial Complex ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Cervical Spine Fractures ◽

Mechanism Of Trauma

Abstract Introduction Cervical spine fractures are particularly prevalent in older people and commonly occur following a fall from standing height or less, in the presence of degenerative spinal disease. Atlanto-axial complex and odontoid process injuries are the most frequent type of fractures and are potentially life threatening. Published in-hospital and 1-year mortality rates in older people are eightfold higher than in younger patients. The aim of this study was to identify the incidence and characteristics of cervical spine fractures in older people presenting to a regional spine centre. Methods Clinical records and radiographs were retrospectively reviewed using our institutional registry covering a 5-year period. Data included patient age, gender, mechanism of trauma, level of fracture, stability of the fracture, treatment modality, imaging modality, and mortality rates. Results A total of 209 patients above the age of 70 with cervical spine fractures were treated in our centre from 2015-2019. The mean age of the patients at the time of injury was (82.4 ±7.5) years with the majority (n=117; 56%) being females. One-hundred fifty-one patients (72.2%) experienced fractures in the atlanto-axial complex. Particularly, Dens fractures were the most commonly reported fracture (n=119; 56.9%). Most of the patients encountered stable cervical spine fractures (n=181; 86.6%) and these were managed by external immobilization with hard collar or halo vest. Mechanism of trauma was divided into two main categories, low energy and high energy. Low energy trauma was the most common cause that lead to cervical spine fractures (n=169; 80.9%), compared to high energy trauma (n=40; 19.1%). CT scan and X-ray were the main imaging modalities utilized to detect cervical spine fractures. Whereas, MRI was only utilized in (n=51; 24.4%). Overall mortality rate was (n=17; 8.1%) at 30 days. Out of which (n=1; 5.9%) was in a patient who was surgically treated while the remaining (n=16; 94.1%) were in those treated conservatively. Conclusions Cervical spine injuries in older people are clinically important. Low energy trauma particularly falls, were the main mechanism of cervical spine injury. Upper cervical spine injuries, mainly C2, is the most common cervical spine fracture and were most commonly detected using CT scan. External immobilization was our treatment of choice for most of the cervical spine injuries in the older people. These patients are very similar with respect to mean age, mechanism of injury and 30 days mortality rate as hip fracture patients.

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Treatment of Cervical Spine Fractures and Subluxations without the Use of Intraoperative Fluoroscopy in Resource-Limited Settings

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0040-1701369 ◽

2020 ◽

Vol 11 (01) ◽

pp. 160-163

Author(s):

Victor-Claude Eyenga ◽

Ignatius N. Esene ◽

Ernestine A. Bikono ◽

Ngah J. Eloundou

Keyword(s):

Cervical Spine ◽

Spine Fractures ◽

Resource Limited Settings ◽

Subaxial Cervical Spine ◽

Resource Limited ◽

Intraoperative Fluoroscopy ◽

Cervical Surgery ◽

Spine Injuries ◽

The Mean ◽

Cervical Spine Fractures

Abstract Background Surgical management of subaxial cervical spine injuries remains challenging. Although intraoperative fluoroscopy is usually used for intraoperative spinal level localization (SLL), it is unavailable in most developing countries. The surgeon therefore has to rely on anatomic landmarks. In our setting, in the absence of intraoperative fluoroscopy, we used the carotid tubercle for SLL. Herein we evaluate the accuracy and reliability of the carotid tubercle as a landmark during surgery for traumatic cervical spine injury. Methods This was a retrospective cohort study on 34 patients undergoing anterior cervical surgery for subaxial cervical spine fractures and/or subluxation between January 2005 and February 2011. From their medical records, the patients’ sociodemographic, clinical, radiological, and operative data were retrieved and analyzed. Results Thirty-four patients were included in the study. The mean age was 36.2 years. Thirty patients were males. The mean duration between the trauma and surgical intervention was 9.6 days. Six patients were completely tetraplegic. Fourteen patients had fractures and 20 patients had subluxation. The carotid tubercle was palpable in all the 34 cases. Twenty-two (68.8%) patients had partial or complete neurologic recovery. Complete anatomic reduction was achieved in 30 cases. One case of slight malalignment of the plate was observed. No case of significant deviation nor penetration of the screw into the vertebral canal was found. One patient died. Conclusions Carotid tubercle, a palpable intrinsic marker, is an attractive anatomic landmark for SLL during surgeries for traumatic spine injuries in resource-limited settings.

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Cervical spine fractures in multiple injured patients in Kurdistan Region, Iraq

Iraq Medical Journal ◽

10.22317/imj.v5i1.1029 ◽

2021 ◽

Vol 5 (1) ◽

Keyword(s):

Cervical Spine ◽

Spine Injury ◽

Spine Fractures ◽

Cervical Injury ◽

Cervical Spine Injuries ◽

Multiple Injured ◽

Spine Injuries ◽

History Of ◽

Cervical Spine Fractures ◽

Time Of Admission

Objectives: The aim of study to describe the main types of cervical spine fractures presented to the emergency department and to illustrate the main aspects of management and outcome. Methods: This is a prospective study of 72 patients with cervical injury out of 932 male patients with history of multiple injuries. All patients with cervical spine injury were admitted within 1 week of injury and follow up thereafter by regular outpatient visit. Cervical spine injuries were diagnosed by full radiological assessment according to NEXUS criteria (plain x-ray with lateral, anteroposterior, odontoid views in addition to cervical spine C.T for indicated patients) and evaluated neurologically. Results: Mean age of patients at time of accident was 25 years ranging from 7-73years, 50% of them were in the third decade of life. Road traffic accidents constitute 58.3% of causes of cervical injury followed by fall from height (19.5%). Results has shown that mid and lower cervical spine injuries constitute 87.5% of all types of vertebra involved while upper cervical spine injuries constitute only 12.5% of them. Associated injuries were found in 42 patients (58.3%) and the most common associated injury was cerebral concussion. 50% of patients had no history of neural deficit at time of admission, while the others had neurological abnormalities (27.7%) of them with complete deficit at time of admission. The most common type of skeletal injury was wedge fracture (28 patients, 38.8%), followed by spinous process fracture and burst fracture (18 patients, 25% and 12 patients, 16.6%) respectively. Respiratory complications were the most common in our series (12 patients of 72, 16.6%) followed by an equal share of urinary tract infection and neck pain (7 patients, 9.7%). Conclusion: Traffic accident constitutes the main reason for cervical spine fractures followed by falls. Cervical spine fractures affect the younger age group with mean age of 25 year. A collar is sufficient treatment for more un displaced fractures. Seat belt is one of the restrains that shares in reduction of fatality and severity of cervical spine injuries.

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History of skeletal traction in the treatment of cervical spine injuries

Journal of Neurosurgery ◽

10.3171/jns.1970.33.1.0054 ◽

1970 ◽

Vol 33 (1) ◽

pp. 54-59 ◽

Cited By ~ 13

Author(s):

John D. Loeser

Keyword(s):

Cervical Spine ◽

Cervical Vertebrae ◽

Spine Fractures ◽

Skeletal Traction ◽

Content Type ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

History Of ◽

Cervical Spine Fractures ◽

Fine Print

✓ Therapy of cervical spine fractures is reviewed from the time of the Egyptians (4000 B.C.) to the present day. Immobilization has been practiced for slightly more than a century; devices for exerting traction upon the skull have been in use for 37 years. The Renaissance surgeon, Fabricus Hildanus, designed a tool for exerting traction upon the cervical vertebrae, but this method did not become popular. Until the 20th century, few physicians considered the therapy of this common injury.

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