Intraoperative Positioning in Maxillofacial Trauma Patients With Cervical Spine Injury – Is It Safe? Radiological Simulation in a Healthy Volunteer

Introduction Cervical spine (C-spine) injury is present in up to 10% of patients with maxillofacial fractures. Uncertainty over the status of the C-spine and permitted head movements may delay maxillofacial surgical intervention, resulting in prolonged patient discomfort and return to oral nutrition, reducing quality of life. This study aimed to investigate the effects on the C-spine of positioning patients for maxillofacial procedures by simulating intraoperative positions for common maxillofacial procedures. Methods Magnetic resonance imaging was used to assess the effects of head position in common intraoperative configurations – neutral (anterior mandible position), extended (tracheostomy position) and laterally rotated (mandibular condyle position) on the C-spine of a healthy volunteer. Results In the tracheostomy position, maximal movement occurred in the sagittal plane between the cervico-occipital junction and C4–C5, as well as at the cervico-thoracic junction. Minimal movement occurred at C2 (on C3), C5 (on C6) and C6 (on C7). In the mandibular condyle position, C-spine movements occurred in both rotational and sagittal planes. Maximal movement occurred above the level of C4, concentrated at atlanto-occipital and atlanto-axial (C1–2) joints. Conclusion Neck extension is likely to be relatively safe in injuries that are stable in flexion and extension, such as odontoid peg fracture and fractures between C5 and C7. Head rotation is likely to be relatively safe in fractures below C4, as well as vertebral body fractures, and laminar fractures without disc disruption. Early dialogue with the neurosurgical team remains a central tenet of safe management of patients with combined maxillofacial and C-spine injuries.

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Comparison of the Bullard and Macintosh Laryngoscopes for Endotracheal Intubation of Patients with a Potential Cervical Spine Injury

Anesthesiology ◽

10.1097/00000542-199712000-00012 ◽

1997 ◽

Vol 87 (6) ◽

pp. 1335-1342 ◽

Cited By ~ 97

Author(s):

Andrew D. J. Watts ◽

Adrian W. Gelb ◽

David B. Bach ◽

David M. Pelz

Keyword(s):

Cervical Spine ◽

General Anesthesia ◽

Endotracheal Intubation ◽

Cervical Spine Injury ◽

Cricoid Pressure ◽

Macintosh Laryngoscope ◽

Spine Injury ◽

Neck Extension ◽

Bullard Laryngoscope ◽

Spine Movement

Background In the emergency trauma situation, in-line stabilization (ILS) of the cervical spine is used to reduce head and neck extension during laryngoscopy. The Bullard laryngoscope may result in less cervical spine movement than the Macintosh laryngoscope. The aim of this study was to compare cervical spine extension (measured radiographically) and time to intubation with the Bullard and Macintosh laryngoscopes during a simulated emergency with cervical spine precautions taken. Methods Twenty-nine patients requiring general anesthesia and endotracheal intubation were studied. Patients were placed on a rigid board and anesthesia was induced. Laryngoscopy was performed on four occasions: with the Bullard and Macintosh laryngoscopes both with and without manual ILS. Cricoid pressure was applied with ILS. To determine cervical spine extension, radiographs were exposed before and during laryngoscopy. Times to intubation and grade view of the larynx were also compared. Results Cervical spine extension (occiput-C5) was greatest with the Macintosh laryngoscope (25.9 degrees +/- 2.8 degrees). Extension was reduced when using the Macintosh laryngoscope with ILS (12.9 +/- 2.1 degrees) and the Bullard laryngoscope without stabilization (12.6 +/- 1.8 degrees; P < 0.05). Times to intubation were similar for the Macintosh laryngoscope with ILS (20.3 +/- 12.8 s) and for the Bullard without ILS (25.6 +/- 10.4 s). Manual ILS with the Bullard laryngoscope results in further reduction in cervical spine extension (5.6 +/- 1.5 degrees) but prolongs time to intubation (40.3 +/- 19.5 s; P < 0.05). Conclusions Cervical spine extension and time to intubation are similar for the Macintosh laryngoscope with ILS and the Bullard laryngoscope without ILS. However, time to intubation is significantly prolonged when the Bullard laryngoscope is used in a simulated emergency with cervical spine precautions taken. This suggests that the Bullard laryngoscope may be a useful adjunct to intubation of patients with potential cervical spine injury when time to intubation is not critical.

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Condition of Vertebral Arteries in Experimental Modelling of Low Cervical Vertebrae Dislocation

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto200411114-19 ◽

2004 ◽

Vol 11 (1) ◽

pp. 14-19 ◽

Cited By ~ 1

Author(s):

S T Vetrile ◽

S V Yundin ◽

A I Krupatkin ◽

S V Kolesov ◽

E V Ogarev ◽

...

Keyword(s):

Cervical Spine ◽

Sagittal Plane ◽

Frozen Section ◽

Cervical Vertebrae ◽

Spine Injury ◽

Experimental Modelling ◽

Vertebral Arteries ◽

Vascular Factor ◽

Choice Of Treatment ◽

External Fixation Device

Condition of vertebral arteries in experimental modeling of cervical vertebrae dislocations at C3-C6 level was studied on 20 section-blocks of cervical spine. Vertebral arteries were contrasted and cervical block was fixed using external fixation device. Various types of dislocation and subluxation under X-ray control were produced. Thus, it was possible to observe dynamic picture of vertebral arteries deformation in traumatic cervical vertebrae dislocation. To confirm the results of angiography the cut up of frozen section-blocks in sagittal plane and in vertebral arteries projection as well as visual control (photography of vertebrae dislocation steps) were performed. Results of experimental study allowed to detect peculiarities of vertebral arteries deformations in cervical vertebrae dislocation and to determine the correlation between the degree of vertebrae dislocation and severity of extracranial vertebral artery deformation. It enables to predict the degree of hemodynamic disorders in the system of vertebral arteries, to determine the role of vascular factor in cervical spine injury and to use the differentional approach to the choice of treatment tactics using routine roentgenography.

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A review of cervical spine injury associated with maxillofacial trauma at a UK tertiary referral centre

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925059633 ◽

2015 ◽

Vol 97 (1) ◽

pp. 66-72 ◽

Cited By ~ 15

Author(s):

S Mukherjee ◽

K Abhinav ◽

PJ Revington

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Road Traffic ◽

Trauma Centre ◽

Maxillofacial Trauma ◽

Spine Injury ◽

Mandibular Fractures ◽

Trauma Patients ◽

Maxillofacial Fracture ◽

Maxillofacial Fractures

Introduction The aim of this study was to determine the incidence and patterns of cervical spine injury (CSI) associated with maxillofacial fractures at a UK trauma centre. Methods A retrospective analysis was conducted of 714 maxillofacial fracture patients presenting to a single trauma centre between 2006 and 2012. Results Of the 714 maxillofacial fracture patients, 2.2% had associated CSI including a fracture, cord contusion or disc herniation. In comparison, 1.0% of patients without maxillofacial trauma sustained a CSI (odds ratio: 2.2, p=0.01). The majority (88%) of CSI cases of were caused by a road traffic accident (RTA) with the remainder due to falls. While 8.8% of RTA related maxillofacial trauma patients sustained a CSI, only 2.0% of fall related patients did (p=0.03, not significant). Most (70%) of the CSIs occurred at C1/C2 or C6/C7 levels. Overall, 455, 220 and 39 patients suffered non-mandibular, isolated mandibular and mixed mandibular/non-mandibular fractures respectively. Their respective incidences of CSI were 1.5%, 1.8% and 12.8% (p=0.005, significant). Twelve patients with concomitant CSI had their maxillofacial fractures treated within twenty-four hours and all were treated within four days. Conclusions The presence of maxillofacial trauma mandates exclusion and prompt management of cervical spine injury, particularly in RTA and trauma cases involving combined facial fracture patterns. This approach will facilitate management of maxillofacial fractures within an optimum time period.

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Cervical spine injury after virtual reality gaming: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02880-9 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

D. Baur ◽

C. Pfeifle ◽

C. E. Heyde

Keyword(s):

Virtual Reality ◽

Case Report ◽

Cervical Spine ◽

Video Game ◽

Cervical Vertebra ◽

Head Movements ◽

Spinal Trauma ◽

Spine Injury ◽

Traumatic Fracture ◽

Seventh Cervical Vertebra

Abstract Background We report a patient who fractured the seventh cervical vertebra while playing a virtual reality (VR) game, without any other trauma. This case report aims to describe the spinal trauma incurred during the use of a VR headset in a video game. Case presentation The Caucasian patient presented with pain and swelling in the lower cervical spine at our clinic after playing a video game involving a combination of shoulder, arm and head movements while wearing a VR headset. Preexisting comorbidities were not present in the 31-year-old male. No history of regular medication use or drug abuse was recorded. After performing a clinical examination and radiological diagnostics, we found a dislocated traumatic fracture of the spinous process of the seventh cervical vertebra. After a soft tissue defect was excluded through magnetic resonance imaging (MRI) diagnostics, a conservative therapy regimen with pain therapy and immobilization was started. After hospitalization, outpatient controls were conducted at 4, 6 and 12 weeks. At 6 weeks after hospitalization, the patient had recovered from the injury without complications. Conclusions Rapid movements during VR gaming can lead to injuries of the cervical spine. In addition to rapid movements, the additional weight of the VR headset as well as the decoupling of audiovisual stimuli from the perceived proprioceptive information should be considered. Determining whether this is an isolated incident induced by unknown preexisting factors or whether the trauma mechanism alone can lead to severe spinal trauma needs to be studied further with additional cases.

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Comparison of TruView and King Vision video laryngoscopes in subaxial cervical spine injury: A randomized controlled trial

Surgical Neurology International ◽

10.25259/sni_638_2020 ◽

2020 ◽

Vol 11 ◽

pp. 375

Author(s):

Rupanwita Sen ◽

Abhinandan Reddy Mallepally ◽

Gayatri Sakrikar ◽

Nandan Marathe ◽

Tushar Rathod

Keyword(s):

Cervical Spine ◽

Soft Tissue ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Neurological Deterioration ◽

Spine Injury ◽

Neck Extension ◽

Cervical Spine Injuries ◽

Subaxial Cervical Spine ◽

Spine Injuries

Background: Airway management with cervical spine immobilization poses a particular challenge for intubation in the absence of neck extension and risks neurological damage in cases of unstable cervical spine injuries. Here, with manual inline stabilization (MILS) in patients with cervical spine injuries, we compared the safety/efficacy of intubation utilizing the TruView versus King Vision video laryngoscopes. Methods: This prospective, single-blind, comparative study was conducted over a 3-year period. The study population included 60 American Society of Anesthesiologists (ASA) Grade I-III patients, aged 18–65 years, who underwent subaxial cervical spine surgery utilizing two intubation techniques; TruView (TV) versus King Vision (KV). For both groups, relative intubation difficulty scores (IDS), total duration of intubation, hemodynamic changes, and other complications (e.g., soft-tissue injury and neurological deterioration) were recorded. Results: With MILS, patients in the KV group had statistically significant lower IDS (0.70 ± 1.02) and significantly shorter duration of intubation as compared to the TV group (1.67 ± 1.27) with MILS (P = 0.0010); notably, the glottic exposure was similar in both groups. The complication rate (e.g., soft-tissue injury) was lower for the KV group, but this was not statistically significant. Interestingly, no patient from either group exhibited increased neurological deterioration attributable to the method of intubation. Conclusion: King Vision has several advantages over TruView for intubating patients who have sustained cervical spine trauma. Nevertheless, both laryngoscopes afford comparable glottic views and safety profiles with similar alterations in hemodynamics.

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