Target-Controlled Infusion of Remifentanil to Provide Analgesia for Awake Nasotracheal Fiberoptic Intubations in Cervical Trauma Patients

Cervical trauma is a serious condition, that may cause permanent disability or even death. Cervical trauma occurs in 2-7% of blunt trauma patients. In Europe, the incidence of cervical trauma is approximately 9-17/100,000 annually,. The most common mechanisms of injury causing cervival trauma are traffic accidents and falls, which the most commonly injured vertebra is vertebral C2 (axis). Diagnostics of cervical trauma are based on good clinical assessment and prompt radiological imaging. Several patient groups, such as the elderly and patients with traumatic brain injury are highly susceptible to cervical trauma. The diagnostics of cervivcal trauma remain challenging for clinical practitioners and failure to diagnose cervical trauma in acute care may have serious consequences.

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Re: Cervical spine MRI in blunt cervical trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000002106 ◽

2018 ◽

Vol 85 (6) ◽

pp. 1133

Author(s):

Adrian A. Maung

Keyword(s):

Cervical Spine ◽

Trauma Patients ◽

Cervical Trauma ◽

Spine Mri

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PROGNOSTIC OUTCOME IN SUBAXIAL CERVICAL SPINE INJURIES MANAGEMENT BY ANTERIOR CERVICAL DYNAMIC PLATE WITH CAGE/GRAFT FIXATION AND POSTERIOR CERVICAL LATERAL MASS SCREW-ROD FIXATION METHODS

10.36106/ijsr/8222303 ◽

2021 ◽

pp. 71-73

Author(s):

Gograj Garhwal ◽

Jitendra Singh Verma ◽

Arvind Ranwa ◽

Debarshi Jana

Keyword(s):

Cervical Spine ◽

Trauma Patients ◽

Lateral Mass ◽

Lateral Mass Screw ◽

Cervical Trauma ◽

Subaxial Cervical Spine ◽

Anterior Cervical Decompression ◽

Classi Cation ◽

Cation Type ◽

Severe Group

Introduction: The anterior cervical decompression and fusion (ACDF)procedures, especially in cases requiring decompression of two or more levels. Routine use for the treatment of cervical spondylosis has caused plate design to change signicantly in recent years. Aim: To estimate the incidence of sub axial cervical trauma patients admitted in the Neurosurgery wards of the institute. To study the therapeutic outcome after management of the subaxial cervical trauma cases by Anterior cervical decompression (discectomy/corpectomy) with graft or cage and dynamic plate xation, posterior lateral mass screw-rod xation, bidirectional single stage combined approach techniques. To compare anterior dynamic plate graft xation with the posterior lateral mass screw rod xation in cases that could be managed by any single approach. Material and methods: This non randomized prospective observational study was conducted in the Department of Neurosurgery, Mahatma Gandhi Medical College & Hospital, Jaipurfrom April 2018 to December 2019. All diagnosed cases of subaxial cervical spine attending and being admitted to our institute during the study period and treated by anterior cervical decompression with dynamic plate xation, posterior lateral mass screw rod xation or combined technique were included in the study. Result:According to AO Spine Classication Type, 10(20.8%) patients had A2, 15(31.3%) patients had A3, 8(16.7%) patients had A4, 1(2.1%) patient had B2, 13(27.1%) patients had C and 1(2.1%) patient had C,F4. It was found that in Non Severe group, 6(31.6%) patients had A3type in AO Spine Classication Type and in severe group 9(31.0%) patients had A3type in AO Spine Classication Type. In Non Severe group, 4(21.1%) patients had C type in AO Spine Classication Type and in Severe group 9(31.0%) patients had C type in AO Spine Classication Type. The association between AO Spine Classication Type vs ASIAImpairment Scale Group was not statically signicant (p=0.6887). Conclusion:In ASIA IMPAIRMENT SCALE GROUP, 5 SLICS1 was higher [6(31.6%)] in Non Severe group and 8 SLICS1 was higher [9(31.0%)] in Severe group which was not statically signicant (p=0.4820).The mean EQ5D post op at 6month of Non Severe (ASIA IMPAIRMENTSCALE) patients was higher than the Severe group of patients which wasstatically signicant (p=0.0442).

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Review of Subaxial Cervical Spine Injuries Presenting to a Tertiary-Level Hospital in Nepal: Challenges in Surgical Management in a Third World Scenario

Global Spine Journal ◽

10.1177/2192568219833049 ◽

2019 ◽

Vol 9 (7) ◽

pp. 713-716 ◽

Cited By ~ 1

Author(s):

Gaurav Raj Dhakal ◽

Ravi Bhandari ◽

Siddartha Dhungana ◽

Santosh Poudel ◽

Ganesh Gurung ◽

...

Keyword(s):

Neurological Recovery ◽

Trauma Patients ◽

Cervical Trauma ◽

Cervical Spine Injuries ◽

Early Access ◽

Subaxial Cervical Spine ◽

Access To Medical Care ◽

Surgery Delay ◽

First World ◽

Level Hospital

Study Design: Epidemiological retrospective study. Objective: To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. Methods: Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. Results: There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. Conclusion: Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.

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Cervical Trauma Patients with Down Syndrome, Case Report

Forbes Journal of Medicine ◽

10.5222/forbes.2020.98608 ◽

2020 ◽

Author(s):

Erkan Güvenç ◽

Merve Saka Güvenç ◽

Burcu Demirdöven

Keyword(s):

Down Syndrome ◽

Case Report ◽

Trauma Patients ◽

Cervical Trauma

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TRAUMATIC CERVICAL SPINAL CORD INJURY. IS URGENT INTERVENTION SUPERIOR TO DELAYED INTERVENTION? A META-ANALYSIS EVALUATION

(JOINTS) Journal Orthopaedi and Traumatology Surabaya ◽

10.20473/joints.v8i1.2019.12-18 ◽

2019 ◽

Vol 8 (1) ◽

pp. 12

Author(s):

I Ketut Martiana ◽

Donny Permana ◽

Lukas Widhiyanto

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Procedure ◽

Cervical Spinal Cord ◽

Meta Analysis ◽

Neurological Status ◽

Trauma Patients ◽

Cervical Trauma ◽

Significant Difference ◽

Cord Injury

Introduction: Cervical spine is the most mobile part of the human spine, thus making it the most vulnerable compared to all the other vertebral structures. Surgical procedures are usually performed within the first 24 hours, or 4-6 weeks after trauma in order to prevent any secondary trauma. The research was conducted to evaluate the amount of time of the surgical procedure towards the effectivity and improvement of the neurological status in the cervical injury or acute spinal cord injury (ASCI).Methods: A meta-analysis research which evaluate the effectivity of surgical procedure on cervical trauma/ASCI, with the database procured from PubMed, Embase, and Cochrane. The main parameter is the decompression procedure and the clinical outcome which were categorized. The time of surgery or decompression are categorized into “<24 hours” and “>24 hours”, the neurological outcome is categorized into “improvement” and “no improvement”. The data was presented in odd ratio (OR) and confidence interval (CI) and were further analyzed by forest plot.Results: From PubMed, there were 353 articles, Embase 2 articles, and Cochrane 594 articles, but only 3 articles which fulfilled the inclusion criteria. The comparison between the surgical procedure in the cervical <24 hours with the surgical procedure >24 hours was identified for this research. Statistically, there was a significant difference on the neurological status (OR=1,85; 95%CI=1,21-2,84; p<0,01).Conclusion: With meta-analysis background, early decompressive procedure <24 hours for cervical trauma patients produced a significantly better result in improving the neurological status compared to the late decompressive procedure >24 hours.

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