Regional injuries of the cervical spine: sports-related anatomical, pathophysiological, and clinical perspectives

2013 ◽  
Author(s):  
Ezequiel Gherscovici ◽  
Eli Baron ◽  
Alexander Vaccaro
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Spinal Column ◽  
Neurological Injury ◽  
Spine Injury ◽  
Sporting Events ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Athletic Field

Cervical spine injuries occur infrequently on the athletic field (Dietz and Lillegard 1999). Nevertheless, sporting events have been reported as the fourth most common cause of spinal cord injury (behind motor vehicle collisions, assaults, and falls) (NSCISC 2006). The possibility of catastrophic cervical spine injury exists with involvement in sports, where it can be defined as ‘structural distortion of the cervical spinal column associated with actual or potential damage to the spinal cord’. This may result in irreversible neurological injury to the athlete (...

scholarly journals Acute traumatic unilateral cervical C4–C5 facet dislocation in pediatric toddlers

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Wongthawat Liawrungrueang ◽  
Rattanaporn Chamnan ◽  
Weera Chaiyamongkol ◽  
Piyawat Bintachitt
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Closed Reduction ◽  
Motor Vehicle ◽  
Rehabilitation Program ◽  
Spine Injury ◽  
Neck Muscle ◽  
Cervical Spine Injuries ◽  
Facet Dislocation ◽  
Cord Injury

Abstract Background The present study is to highlight the challenges in managing cervical spine injuries in toddlers (less than 4 years of age) without neurological deficit. Cases of unilateral cervical C4–C5 facet dislocation in toddlers are very rare. Case presentation A 3-year-old girl suffered cervical spine injury after a motor vehicle collision with unilateral C4–C5 facet dislocation without neurological deficit. Magnetic resonance imaging (MRI) showed no spinal cord injury, Frankel grade E. Initial management was cervical spine protection. Definite treatment and complication were discussed with the patient’s parents before closed reduction maneuver with minerva cast was applied under sedation. The patient showed no complication after closed reduction and the cervical spine had aligned well in radiographs. The minerva cast was removed at 8 weeks, at which point neck muscle stretching rehabilitation program started. At one-year follow up, the child was asymptomatic, had full active cervical motion and good function. In radiographs, the cervical spine had normal alignment and was healed. Conclusions Unilateral cervical facet dislocation in toddlers is very rare. Closed reduction maneuver and the minerva cast applied were optional in this case. The parents were highly satisfied with the effective treatment and outcome.

Evaluation of cervical spine injury and predicting neurological deficit by magnetic resonance imaging

2021 ◽  
Vol 12 (2) ◽  
pp. 92-97
Author(s):  
Sushant H Bhadane ◽  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Mr Imaging ◽  
Neurological Deficit ◽  
Spine Injury ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Spine Injuries ◽  
Posterior Element

Background: The consequences of cervical spine injuries range from simple neck pain, to quadriplegia, or even death. MR imaging has become part of the diagnostic and prognostic tools for spinal cord injury. Aim: To prospectively evaluate cervical spine injuries by MR imaging and to find out association of MR imaging findings with degree of neurological deficit. Material and Methods: Descriptive longitudinal hospital based study was conducted on 30 patients with known or suspected cervical spine trauma who presented to the emergency department. Results: Mean age of the cases was about 42 years, with female to male ratio of 1:6.5. C6-C7 spinal level was most commonly involved. Proportions complete spinal cord injury (CSCI), incomplete spinal cord injury (ISCI) and neurologically normal (NN) were 23.33%, 60% and 16.67% respectively. Out of 12 MRI findings, cord haemorrhage, contusion, posterior element fracture, disc injury, prevertebral hematoma, subluxation and soft tissue injury was statistically associated with degree of neurological deficit. Cord contusion, cord haemorrhage and posterior element fracture were potential predictors of neurological status at admission. Cord contusion, cord haemorrhage and subluxation were potential predictors at 3 months. Conclusion: MRI proved a pivotal role in the diagnosis of SCIs, deciding prompt management and predicting neurological deficit and prognosis of neurological recovery. So, MRI is an excellent diagnostic modality for the evaluation of spinal trauma and predicting the degree of neurological deficit and recovery.

Management of Athletic Injuries of the Cervical Spine and Spinal Cord

Neurosurgery ◽  
1991 ◽  
Vol 29 (4) ◽  
pp. 491-497 ◽  
Author(s):  
Julian E. Bailes ◽  
Mark N. Hadley ◽  
Matthew R. Quigley ◽  
Volker K.H. Sonntag ◽  
Leonard J. Cerullo
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Vertebral Column ◽  
Sporting Events ◽  
Cervical Spine Injuries ◽  
Contact Sports ◽  
Cord Injury ◽  
Spine Injuries

Abstract Injuries to the cervical spine among athletes present inherent difficulties, especially in advising for return to contact sports. Experience with the acute care of 63 patients who sustained cervical spine injuries while participating in organized sporting events is analyzed. Forty-five patients had permanent injury to the vertebral colum n and/or spinal cord, while 18 suffered only transient spinal cord symptoms. Football mishaps accounted for the highest number of injuries, followed by wrestling and gymnastics. Twelve patients had complete spinal cord injury, 14 patients had incomplete spinal cord injury, and 19 patients had injury to the vertebral column alone. The majority of the spinal cord lesions occurred at the C4 and C5 levels, while bony injuries of C4 through C6 predominated. Twenty-five patients required surgical stabilization, and 20 were treated with orthosis only. There was no instance of associated systemic injuries, and hospital complications were few. The mean time of hospitalization was 19.1 days for injured patients and 3.0 days for patients with transient symptoms. A classification was developed to assist in the management of these patients: Type 1 athletic injuries to the cervical spine are those that cause neurological injury; patients with Type 1 injuries are not allowed to participate in contact, competitive sporting events. Type 2 injuries consist of transient neurological deficits without radiological evidence of abnormalities; these injuries usually do not prohibit further participation in contact sports unless they become repetitive. Type 3 injuries are those that cause radiological abnormality alone; these represent a heterogeneous group. The athlete with fractures involving a significant structural portion of the vertebral column, ligament instability, spinal cord contusion, or congenital cervical stenosis, is advised not to return to contact sports. Other radiological abnormalities, such as compromise of the ligaments, congenital fusion, degenerative disease, and herniated cervical disc require individual consideration. The rationale for treatment and advising for participation in sports are discussed. We believe that this classification of sports injuries offers clinicians a framework within which to make rational judgments and recommendations in the management of athletes with cervical spine injuries.

scholarly journals Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0008
Author(s):  
Bram P Verhofste ◽  
Daniel J Hedequist ◽  
Craig M Birch ◽  
Emily S Rademacher ◽  
Michael P Glotzbecker ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Trauma Center ◽  
Youth Sports ◽  
Axial Loading ◽  
Permanent Disability ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Spine Injuries ◽  
Level 1

Background: Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes. Hypothesis/Purpose: The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports. Methods: We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI). Results: Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003). Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity. Conclusion: The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability. [Figure: see text][Table: see text][Table: see text]

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?

Association of Head Trauma with Cervical Spine Injury, Spinal Cord Injury, or Both

1999 ◽  
Vol 46 (3) ◽  
pp. 450-452 ◽  
Author(s):  
Hideo Iida ◽  
Shigekuni Tachibana ◽  
Takao Kitahara ◽  
Shigeharu Horiike ◽  
Takashi Ohwada ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Head Trauma ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Cord Injury

scholarly journals Cervical spine injuries in pediatric athletes: mechanisms and management

2006 ◽  
Vol 21 (4) ◽  
pp. 1-5 ◽  
Author(s):  
Jay Jagannathan ◽  
Aaron S. Dumont ◽  
Daniel M. Prevedello ◽  
Christopher I. Shaffrey ◽  
John A. Jane
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Pediatric Patients ◽  
Head Injuries ◽  
Axial Loading ◽  
Cervical Region ◽  
Spine Injury ◽  
Severe Injuries ◽  
Cervical Spine Injuries ◽  
Cord Injury

✓Sports-related injuries to the spine, although relatively rare compared with head injuries, contribute to significant morbidity and mortality in children. The reported incidence of traumatic cervical spine injury in pediatric athletes varies, and most studies are limited because of the low prevalence of injury. The anatomical and biomechanical differences between the immature spine of pediatric patients and the mature spine of adults that make pediatric patients more susceptible to injury include a greater mobility of the spine due to ligamentous laxity, shallow angulations of facet joints, immature development of neck musculature, and incomplete ossification of the vertebrae. As a result of these differences, 60 to 80% of all pediatric vertebral injuries occur in the cervical region. Understanding pediatric injury biomechanics in the cervical spine is important to the neurosurgeon, because coaches, parents, and athletes who place themselves in positions known to be associated with spinal cord injury (SCI) run a higher risk of such injury and paralysis. The mechanisms of SCI can be broadly subclassified into five types: axial loading, dislocation, lateral bending, rotation, and hyperflexion/hyperextension, although severe injuries often result from a combination of more than one of these subtypes. The aim of this review was to detail the characteristics and management of pediatric cervical spine injury.

Halo-thoracic brace immobilization in 188 patients with acute cervical spine injuries

1983 ◽  
Vol 58 (4) ◽  
pp. 508-515 ◽  
Author(s):  
Richard C. Chan ◽  
Joseph F. Schweigel ◽  
Gordon B. Thompson
Keyword(s):  
Cervical Spine ◽  
Early Mobilization ◽  
Fusion Rate ◽  
Spine Injury ◽  
Cervical Cord ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Cervical Fractures ◽  
Cord Injury ◽  
Skull Traction

✓ The authors report 188 patients with acute cervical spine injury with fracture who underwent Halothoracic brace immobilization. The majority of the fractures were considered unstable. Early neurological assessment revealed 24 patients without neurological deficit. There were 164 patients with associated cervical cord injury; 84 patients with incomplete, and 80 patients with complete tetraplegia. Management consisted of skull traction and application of the Halo-thoracic brace about 1.3 weeks after admission. The average radiological union time was 11.5 weeks following a mean of 10.2 weeks of immobilization in a Halo apparatus. Satisfactory restoration of bone and ligament stability, with no significant posttreatment neck pain, was obtained in 168 cases (89%). This is comparable to the fusion rate achieved for cervical fractures in the literature. The follow-up periods range from 1 month to 6 years, with a mean of 10.8 months. The management and results in 73 patients with unilaterally and bilaterally locked facets with or without fractures are discussed. Complete tetraplegia is not considered a contraindication to Halo apparatus immobilization. The multiple factors responsible for overcoming the barrier of anesthetic skin are elucidated. Use of the Halo apparatus offers early mobilization and rehabilitation without neurological deterioration. Complications are few and insignificant.

scholarly journals A Nearly Lethal Screw: An Unusual Cause of Recurrent Bradycardia and Asystole Episodes after Fixation of the Cervical Spine

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Amit Frenkel ◽  
Yair Binyamin ◽  
Evgeni Brotfain ◽  
Leonid Koyfman ◽  
Aviel Roy-Shapira ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Injury ◽  
Cervical Cord ◽  
Unstable Fracture ◽  
Cervical Spine Injuries ◽  
Cord Injury ◽  
Fixation Screw ◽  
Direct Pressure ◽  
History Of ◽  
High Cervical

We present a case of a 51-year-old man who was injured in a bicycle accident. His main injury was an unstable fracture of the cervical and thoracic vertebral column. Several hours after his arrival to the hospital the patient underwent open reduction and internal fixation (ORIF) of the cervical and thoracic spine. The patient was hospitalized in our critical care unit for 99 days. During this time patient had several episodes of severe bradycardia and asystole; some were short with spontaneous return to sinus and some required pharmacological treatment and even Cardiopulmonary Resuscitation (CPR). Initially, these episodes were attributed to the high cervical spine injury, but, later on, CT scan suggested that a fixation screw abutted on the esophagus and activated the vagus nerve by direct pressure. After repositioning of the cervical fixation, the bradycardia and asystole episodes were no longer observed and the patient was released to a rehabilitation ward. This case is presented in order to alert practitioners to the possibility that, after operative fixation of cervical spine injuries, recurrent episodes of bradyarrhythmia can be caused by incorrect placement of the fixation screws and might be confused with the natural history of the high cervical cord injury.

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