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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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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Currently available classification systems for lower cervical spine injuries. Part 1. Overview of the most popular scales and classifications

Russian journal of neurosurgery ◽

10.17650/1683-3295-2019-21-1-90-102 ◽

2019 ◽

Vol 21 (1) ◽

pp. 90-102 ◽

Cited By ~ 1

Author(s):

A. A. Grin ◽

I. S. Lvov ◽

S. L. Arakelyan ◽

A. E. Talypov ◽

A. Yu. Kordonsky ◽

...

Keyword(s):

Cervical Spine ◽

Classification System ◽

Injury Severity ◽

Scoring Systems ◽

Classification Systems ◽

Spine Injury ◽

Lower Cervical Spine ◽

Cervical Spine Injuries ◽

Advantages And Disadvantages ◽

Spine Injuries

This article provides a detailed illustrated description of currently available classification and scoring systems for lower cervical spine injuries (including Allen–Fergusson, J. Harris et al., C. Argenson et al., and AOSpine classifications, Subaxial Injury Classification System and Cervical Spine Injury Severity Score). The present review primarily aims to discuss the advantages and disadvantages of each classification system.

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Cervical spine injuries

The Neurosurgeon's Handbook ◽

10.1093/med/9780198570677.003.0204 ◽

2010 ◽

pp. 276-286

Author(s):

George Samandouras

Keyword(s):

Cervical Spine ◽

Occipital Condyle ◽

Spine Fractures ◽

Cervical Spine Injuries ◽

Occipital Condyle Fracture ◽

Subaxial Cervical Spine ◽

Spine Injuries ◽

Condyle Fracture ◽

Cervical Spine Fractures

Chapter 6.6 covers cervical spine injuries, including atlanto-occipital dislocation (AOD), occipital condyle fracture (OCF), fracture of the atlas: C1 (FOTA), fracture of the axis: C2 (FOAX), combination fractures: C1–C2, atlanto-axial instability (AAI), and subaxial cervical spine fractures.

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

CJEM ◽

10.2310/8000.2013.130978 ◽

2014 ◽

Vol 16 (02) ◽

pp. 131-135 ◽

Cited By ~ 3

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.

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Cervical Spine Injury is Rare in Self-Inflicted Craniofacial Gunshot Wounds: An Institutional Review and Comparison to the US National Trauma Data Bank (NTDB)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x20000771 ◽

2020 ◽

Vol 35 (5) ◽

pp. 524-527

Author(s):

Allison G. McNickle ◽

Paul J. Chestovich ◽

Douglas R. Fraser

Keyword(s):

Cervical Spine ◽

Spinal Surgery ◽

Gunshot Wounds ◽

Data Bank ◽

Spine Injury ◽

Spine Fractures ◽

National Trauma ◽

National Trauma Data Bank ◽

The Us ◽

Cervical Spine Fractures

AbstractBackground:Cadaveric and older radiographic studies suggest that concurrent cervical spine fractures are rare in gunshot wounds (GSWs) to the head. Despite this knowledge, patients with craniofacial GSWs often arrive with spinal motion restriction (SMR) in place. This study quantifies the incidence of cervical spine injuries in GSWs to the head, identified using computerized tomography (CT). Fracture frequency is hypothesized to be lower in self-inflicted (SI) injuries.Methods:Isolated craniofacial GSWs were queried from this Level I trauma center registry from 2013-2017 and the US National Trauma Data Bank (NTDB) from 2012–2016 (head or face abbreviated injury scale [AIS] >2). Datasets included age, gender, SI versus not, cervical spine injury, spinal surgery, and mortality. For this hospital’s data, prehospital factors, SMR, and CTs performed were assessed. Statistical evaluation was done with Stata software, with P <.05 significant.Results:Two-hundred forty-one patients from this hospital (mean age 39; 85% male; 66% SI) and 5,849 from the NTDB (mean age 38; 84% male; 53% SI) were included. For both cohorts, SI patients were older (P < .01) and had increased mortality (P < .01). Overall, cervical spine fractures occurred in 3.7%, with 5.4% requiring spinal surgery (0.2% of all patients). The frequency of fracture was five-fold greater in non-SI (P < .05). Locally, SMR was present in 121 (50.2%) prior to arrival with six collars (2.5%) placed in the trauma bay. Frequency of SMR was similar regardless of SI status (49.0% versus 51.0%; P = not significant) but less frequent in hypotensive patients and those receiving cardiopulmonary resuscitation (CPR). The presence of SMR was associated with an increased use of CT of the cervical spine (80.0% versus 33.0%; P < .01).Conclusion:Cervical spine fractures were identified in less than four percent of isolated GSWs to the head and face, more frequently in non-SI cases. Prehospital SMR should be avoided in cases consistent with SI injury, and for all others, SMR should be discontinued once CT imaging is completed with negative results.

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Neck Injury

Pediatrics in Review ◽

10.1542/pir.16.1.28 ◽

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.

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A study on functional outcome following surgical fixation for lower spine injuries

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20212773 ◽

2021 ◽

Author(s):

M. Sivakumar ◽

M. Ganesh Kumar

Keyword(s):

Cervical Spine ◽

Functional Outcome ◽

Tamil Nadu ◽

Spinal Injury ◽

Spine Injury ◽

Trauma Patients ◽

Cervical Spine Injuries ◽

Spine Injuries ◽

Disc Bulge ◽

Surgical Fixation

Background: Cervical spine injuries are one of the common causes of serious morbidity mortality following trauma. 6% of trauma patients have spine injuries of which >50% is contributed by a cervical spine injury. The aim of the study was to determine the functional outcome following surgical fixation for sub-axial cervical spine.Methods: this prospective study involving 17 patients who were all admitted with sub-axial cervical spine injuries and amenable to intervention in our department of orthopedics and traumatology, government Theni medical college, Tamil Nadu, India in the year 2019-2020. Duration of 6 months from December 2019 to may 2020.Results: Most of the injuries presented within 24 hours of injury. Most of the patients presented with an incomplete neurological deficit. C5-C6 subluxation with disc bulge was the most common spinal injury. 5 patients were operated on more than 2 levels. The rest of the patients were operated on at 2 levels.Conclusions: We consider that the anterior decompression and fusion with a locking compression plate is a viable procedure in sub-axial cervical spine injuries.

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The classifications of subaxial cervical spine traumatic injuries. Part 4. AOSpine Subaxial Classification System

Ukrainian Neurosurgical Journal ◽

10.25305/unj.223287 ◽

2021 ◽

Vol 27 (1) ◽

pp. 3-10

Author(s):

Oleksii S. Nekhlopochyn ◽

Ievgenii I. Slynko ◽

Vadim V. Verbov

Keyword(s):

Cervical Spine ◽

Treatment Strategy ◽

Classification System ◽

Neurological Status ◽

Classification Systems ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries ◽

Injury Classification

Cervical spine injuries are a fairly common consequence of mechanical impact on the human body. The subaxial level of the cervical spine accounts for approximately half to 2/3 of these injuries. Despite the numerous classification systems that exist for describing these injuries, the recommendations for treatment strategy are very limited, and currently none of them is universal and generally accepted. Consequently, treatment decisions are based on the individual experience of the specialist, but not on evidence or algorithms. While the classification system based on the mechanism of trauma originally proposed by B.L. Allen et al. and subsequently modified by J.H. Harris Jr et al., was comprehensive, but lacked evidence, which to some extent limited its clinical applicability. Similarly, the Subaxial Injury Classification System proposed by the Spine Trauma Group, had no distinct and clinically significant patterns of morphological damage. This fact hindered the standardization and unification of tactical approaches. As an attempt to solve this problem, in 2016 Alexander Vaccaro, together with AO Spine, proposed the AO Spine subaxial cervical spine injury classification system, using the principle of already existing AOSpine classification of thoracolumbar injuries. The aim of the project was to develop an effective system that provides clear, clinically relevant morphological descriptions of trauma patterns, which should contribute to the determination of treatment strategy. The proposed classification of cervical spine injuries at the subaxial level follows the same hierarchical approach as previous AO classifications, namely, it characterizes injuries based on 4 parameters: (1) injury morphology, (2) facet damage, (3) neurological status, and (4) specific modifiers. The morphology of injuries is divided into 3 subgroups of injuries: A (compression), B (flexion-distraction), and C (dislocations and displacements). Damage types A and B are divided into 5 (A0-A4) and 3 (B1-B3) subtypes, respectively. When describing damage of the facet joints, 4 subtypes are distinguished: F1 (fracture without displacement), F2 (unstable fracture), F3 (floating lateral mass) and F4 (dislocation). The system also integrates the assessment of neurological status, which is divided into 6 subtype). In addition, the classification includes 4 specific modifiers designed to better detail a number of pathological conditions. The performance evaluation of AOSpine SCICS showed a moderate to significant range of consistency and reproducibility. Currently, a quantitative scale for assessing the severity of classification classes has been proposed, which also, to a certain extent, contributes to decision-making regarding treatment strategy.

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