scholarly journals Cervical vertebral injuries associated with the ossification of the posterior longitudinal ligament: Imaging features

2017 ◽  
Vol 6 (3) ◽  
pp. 205846011769585 ◽  
Author(s):  
Tetsuo Nakayama ◽  
Shigeru Ehara
Keyword(s):  
Cervical Spine ◽  
Posterior Longitudinal Ligament ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Spine Fractures ◽  
Minor Trauma ◽  
Imaging Features ◽  
Cervical Fractures ◽  
Different Types ◽  
Cervical Spine Fractures

Background Spinal injuries associated with ossification of the posterior longitudinal ligament (OPLL) have been characterized. However, the imaging features of traumatic cervical spine fractures in patients with OPLL have not been assessed adequately. Purpose To characterize the patterns of traumatic cervical spine fractures associated with different types of OPLL. Material and Methods We retrospectively analyzed the patterns of fractures resulting from cervical spine injury in patients with OPLL of different types and assessed the fracture patterns in patients with ankylosed segments. Results Twenty-six patients (23 men, 3 women; median age, 67.0 years; age range, 43–87 years) were included. Fall from a height <3 m was the most common trauma. Contiguous type OPLL was seen in 11 patients (42%), segmental type in 11 (42%), and mixed type in four (15%). Four of the contiguous OPLL and one of the mixed OPLL patients had ankylosed segments. The incidence of cervical fractures was 69% (16/26): seven (64%) in contiguous OPLL, five (46%) in segmental OPLL, and in all four patients with mixed OPLL. Unilateral interfacetal fracture-dislocation was most common (4/16); the others were bilateral interfacetal fracture-dislocation, fractures through the ankylosed segment, transdiscal fractures, isolated facet fractures, and compression fractures. Cervical fractures were exclusively observed in the C4 to C7, except in one case occurred at the C2 level. Conclusion Interfacetal fracture-dislocation in the lower cervical vertebrae constitutes the most common injury resulting from minor trauma.

CONVENTIONAL X-RAY AND COMPUTED TOMOGRAPHY FINDINGS OF CERVICAL SPINE TRAUMA

2016 ◽  
pp. 12-19
Author(s):  
Hoang Minh Thi Nguyen ◽  
Thanh Thao Nguyen
Keyword(s):  
Cervical Spine ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Posterior Arch ◽  
Spine Fractures ◽  
Cervical Spine Trauma ◽  
Lower Cervical Spine ◽  
Spine Trauma ◽  
X Ray ◽  
Cervical Spine Fractures

Background: Cervical spine trauma is a serious and complicated injury, affects both spine and spine cord. Evaluation of cervical spine trauma is crucial for selecting effective treatment methods. Purposes: To describe characteristics on X-ray and CT scanner of the cervical spine in trauma and to evaluate the value of X-ray for the cervical spine trauma. Materials and Method: A cross-sectional study of 33 patients with cervical spine injury seen on CT from 08/2014 to 08/2015 at Hue Central Hospital and Hue University Hospital. Results: Average age was 43 years. The majority was males (the ratio was 4.5). The most common reason of injury were motor vehicle crashes and labor accidents. The most common site of injury was C5 - C6 level. There were 4/33 cases of upper cervical spine fractures and there were 29/33 cases of lower cervical spine fractures, in which blunt fracture, dislocation fracture, simple fracture were mainly identified on CT than on X-ray, p <0.05. The Kappa value for measuring the realiability between X-ray and CT in findings of body spine fractures was moderate (0.41 < K = 0.598 < 0.6). The ratio in finding posterior arch of lower cervical spine fractures on CT were higher than on X-ray, particularly in laminar frature and multiple sites fracture. There was no diagnostic suitability between X-ray and CT in detecting posterior arch of lower cervical spine fractures, K= 0.115 < 0.2. Conclusion: X-ray is still valuable in clinical practice in medical facilities that have not been equipped with modern specialized equipment in odontoid fracture type 2, Hangman fracture and dislocated injuries besides using CT and MRI. Key words: Cervical vertebrate; Trauma; Morphologic characteristics

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

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.

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?

Management of cervical spine injuries in patients with ankylosing spondylitis

1990 ◽  
Vol 72 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Karl N. Detwiler ◽  
Christopher M. Loftus ◽  
John C. Godersky ◽  
Arnold H. Menezes
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Minor Trauma ◽  
Loss Of Function ◽  
Traumatic Fracture ◽  
Axial Traction

✓ Eleven patients with ankylosing spondylitis and traumatic fracture/dislocation of the spine were identified in a retrospective review of all cases of cervical spine injury treated on the neurosurgical service over a 10-year period. Injury was most often secondary to minor trauma or a motor-vehicle accident, and the level of vertebral involvement was most frequently between C-5 and T-1. Neurological symptoms at presentation ranged from neck pain alone to complete loss of function distal to the level of injury. Initial routine treatment consisted of axial traction for realignment with the minimal weight needed to accomplish this, taking into account the flexion deformity. All patients underwent pluridirectional tomography and/or computerized tomography to delineate the exact sites of injury. Three patients died shortly after admission due to pulmonary complications. The remaining eight patients underwent early posterior stabilization and mobilization in a halo or cervicothoracic brace to achieve fusion. Neurological improvement was achieved in six of these eight cases. The experience described here supports the initiation of axial traction as initial therapy for cervical injuries followed by early surgical stabilization in patients with ankylosing spondylitis. The difficulty of maintaining spinal alignment and the devastating pulmonary problems attendant on conservative management may be obviated by early fusion.

scholarly journals LO027: Cervical spine injury in trauma patients 65 years and older immobilised in the prehospital setting

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S39-S39
Author(s):  
L. Lamy ◽  
J. Chauny ◽  
D. Ross
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Trauma Patients ◽  
Minor Trauma ◽  
Cervical Injury ◽  
Geriatric Population ◽  
Spinal Immobilisation ◽  
A Minor

Introduction: Following a protocol derived from the Canadian C-spine Rule (CCR), patients 65 years and older transported by ambulance after trauma require full spinal immobilisation. Immobilisation complicates the transport and the evaluation; potential side effects have been recognized. The aim of this study was to evaluate the effect of mechanism of trauma and age on the rate of cervical injury in a geriatric population. Methods: We conducted a retrospective observational study on patients 65 years and older transported by ambulance to a level-one trauma center from March 2008 to October 2013. The outcome was the rate of clinically important cervical spine injury (CICSI), defined as any fracture, dislocation or ligamentous injury needing treatment or specialised follow up. The rate was calculated in the geriatric population and in the subgroup of patients with minor trauma, defined as a fall from a standing height, a chair or a bed. We then looked at the rate of CICSI based on age to define a subgroup at lower risk of lesion. Results: We included 1221 patients with a mean age of 80 y.o. (SD = 8), 739 women (61%). CICSI was found in 53 patients (4.3%, 95% CI 3.2-5.4). This is similar to the rate found in patients 65 years and older in the NEXUS population (4.6%) and the CCR population (6.0%). The mechanism of injury was a minor trauma for 716 patients (59%). Of those, 24 patients (3.4%, 95% CI 2.1-4.7) had CICSI. The rate increased after 85 y.o in both the overall population (3.4% vs 6.4%) and the minor trauma subgroup (2.6% vs 4.4%). Conclusion: The subgroup of patients 65-84 y.o. with a minor trauma had the lower rate of cervical spine injury (2.6%). In a lot of prehospital systems, those patients are not systematically immobilised for transport. It will be interesting to review the files of all patients with CICSI to identify any possible case that would have been missed without the age criteria.

Trauma Imaging of the Acute Cervical Spine

2017 ◽  
Vol 21 (03) ◽  
pp. 184-198 ◽  
Author(s):  
Daniela Berritto ◽  
Antonio Pinto ◽  
Paul Michelin ◽  
Xavier Demondion ◽  
Sammy Badr
Keyword(s):  
Cervical Spine ◽  
Emergency Radiology ◽  
Surgical Intervention ◽  
Wide Spectrum ◽  
Spine Fractures ◽  
Imaging Features ◽  
Spine Trauma ◽  
Complex Anatomy ◽  
Cervical Spine Fractures ◽  
Significant Injury

Among patients admitted in emergency departments for acute cervical spine trauma, only a few have a confirmed and significant injury requiring surgical intervention. Imaging plays a key role in screening for unstable lesions that can be responsible for devastating neurologic complications or death. The complex anatomy of the cervical spine is associated with a wide spectrum of osseous and ligamentous pathologies. This review focuses on the imaging features of the main cervical spine fractures that can be encountered in emergency radiology.

Esophageal and Hypopharyngeal Injuries in Patients with Cervical Spine Trauma

1981 ◽  
Vol 90 (4) ◽  
pp. 323-327 ◽  
Author(s):  
Richard A. Pollock ◽  
David F. Apple ◽  
John M. Purvis ◽  
Herdon Murray
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Cervical Spine Fracture ◽  
Recent Experience ◽  
Spine Trauma ◽  
Radiographic Study ◽  
Cervical Fractures ◽  
Unexplained Fever

The authors review their recent experience with four patients referred to the Shepherd Spinal Center, Atlanta, with cervical spine fracture dislocation and quadriplegia. The patients were subsequently found to have tears of the hypopharynx or the esophagus as a complication of their injury. Unexplained fever, swelling of the neck, dysphagia or leukocytosis in the patient with acute cervical spine injury suggest, the authors urge, the possibility of esophageal or hypopharyngeal perforation. The authors review the kinematics and pathophysiology of cervical fractures and provide clues to early detection and management of perforation of the hypopharynx or esophagus, including the use of radiographic study and endoscopy.

scholarly journals Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center

2016 ◽  
Vol 6 (1) ◽  
pp. 21-25
Author(s):  
Christopher P Miller ◽  
Sonya T Blizzard ◽  
Jonathan N Grauer
Keyword(s):  
Cervical Spine ◽  
Trauma Center ◽  
Demographic Data ◽  
High Energy ◽  
Consecutive Series ◽  
Spine Fractures ◽  
Diagnosis And Management ◽  
Cervical Fractures ◽  
Level I ◽  
Cervical Spine Fractures

ABSTRACT Background In an effort to capture all cervical fractures in the trauma setting, many institutions have implemented protocols for urgent cervical computed tomographic (CT) imaging for any patient with traumatic neck pain. This has led to a high frequency of negative imaging studies. Objectives The objective is to characterize a consecutive series of cervical spine fractures diagnosed at a single Level I trauma center over a 10-year period. It is expected that a greater awareness of the associations between age, injury mechanism, and fracture type may facilitate the diagnosis and management of patients with cervical spine trauma. Methods In this study, every cervical CT scan ordered in the Emergency Department (ED) at our institution was reviewed and evaluated for fractures. The relevant demographic data and mechanism of injury for patients with fractures were recorded. Results Of 763,099 ED visits, 13,896 cervical CT scans were ordered (1.8% of visits) and 492 scans (3.5% of scans, 0.06% of visits) were found to have cervical fractures resulting from blunt trauma. There was a bimodal distribution of fractures with respect to age, with peaks at 20 to 24 and >85 years of age. These age ranges were also found to have higher incidence of fracture than would be predicted by population alone. Fractures in younger patients resulted from high-energy trauma and fractures in older patients resulted primarily from falls. Conclusion This elucidation of epidemiology and mechanism of cervical fractures can be used to improve the rapidity of diagnosis and management of these potentially devastating injuries. Blizzard DJ, Miller CP, Blizzard ST, Grauer JN. Incidence and Demographics of Cervical Spine Fractures over a 10 Year Period at a Level I Trauma Center. The Duke Orthop J 2016;6(1):21-25.

scholarly journals Cervical Computed Tomography Angiography Rarely Leads to Intervention in Patients With Cervical Spine Fractures

2019 ◽  
Vol 10 (8) ◽  
pp. 992-997
Author(s):  
Conor John Dunn ◽  
Stuart Changoor ◽  
Kimona Issa ◽  
Jeffrey Moore ◽  
Nancy J. Moontasri ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Computed Tomography Angiography ◽  
Neurological Deficits ◽  
Cervical Region ◽  
Trauma Patients ◽  
Spine Fractures ◽  
Cervical Fractures ◽  
Cervical Spine Fractures ◽  
The Impact

Study Design: Retrospective cohort study. Objectives: To evaluate the impact of computed tomography angiography (CTA) in the management of trauma patients with cervical spine fractures by identifying high-risk patients for vertebral artery injury (VAI), and evaluating how frequently patients undergo subsequent surgical/procedural intervention as a result of these findings. Methods: All trauma patients with cervical spine fractures who underwent CTA of the head and neck at our institution between January 2013 and October 2017 were identified. Patients were indicated for CTA according to our institutional protocol based on the modified Denver criteria, and included patients with cervical fractures on scout CT. Those with positive VAI were noted, along with their fracture location, and presence or absence of neurological deficit on physical examination. Statistical analysis was performed and odds ratios were calculated comparing the relationship of cervical spine fracture with presence of VAI. Results: A total of 144 patients were included in our study. Of those, 25 patients (17.4%) were found to have VAI. Two patients (1.4%) with VAI underwent subsequent surgical/procedural intervention. Of the 25 cervical fractures with a VAI, 20 (80%), were found to involve the upper cervical region (4.2 OR, 95% CI 1.5-12.0; P = .007). Of the 25 who had a VAI, 9 were unable to undergo reliable neurologic examination. Of the remaining 16 patients, 5 (31.3%) had motor or sensory deficits localized to the side of the VAI, with no other attributable etiology. Conclusions: Cervical spine fractures located in the region of the C1-C3 vertebrae were more likely to have an associated VAI on CTA. VAI should also be considered in cervical trauma patients who present with neurological deficits not clearly explained by other pathology. Despite a finding of VAI, patients rarely underwent subsequent surgical or procedural intervention.

scholarly journals Outcomes of Halo Immobilization for Cervical Spine Fractures

2019 ◽  
Vol 9 (5) ◽  
pp. 521-526 ◽  
Author(s):  
Stacey Isidro ◽  
Robert Molinari ◽  
Tochukwu Ikpeze ◽  
Cesar Hernandez ◽  
Mohamed Salah Mahmoudi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Success ◽  
Complication Rates ◽  
Spine Fractures ◽  
Fracture Length ◽  
Cervical Fractures ◽  
Upper Cervical ◽  
Level I ◽  
Cervical Spine Fractures

Study Design: Retrospective. Objectives: To evaluate complications and outcomes of halo immobilization in patients with cervical spine fractures treated at a level I trauma center. Methods: A retrospective evaluation of patients treated at a single institution with halo immobilization from August 2000 to February 2016 was performed. Demographic information, mechanism of injury, level and type of spine fracture, length of halo immobilization, complications associated with halo immobilization, and length of patient follow-up were collected. Results: A total of 189 patients treated with halos were identified. Of the 189 patients, 121 (64%) received halos for the management of cervical spine fractures and were included in the study. A total of 49.6% were males and 50.4% were females. The average age was 50.8 years (range 1-89 years). Overall, 10.7% sustained C1 fractures, 71.1% C2 fractures, and 18.2% subaxial spine (C3-C7) fractures. In all, 47.1% of the upper cervical fractures were either odontoid or hangman-type fractures. A total of 25.1% of patients had multiple cervical fractures. At latest follow-up, 81% had healed fractures with good alignment, minimal pain, and return to normal activities. There was an 8.3% mortality rate. The mortality group had an average age of 64.7 years (range 19-84 years). A total of 10.7% of patients failed halo immobilization and 46.3% of patients had complications such as pin site infections (5.8%), loose pins (1.7%), neck pain (20.7%), decreased range of motion (14%), thoracic skin ulcers (2.4%), and dysphagia (1.7%). Conclusions: The use of halo immobilization for cervical spine fractures resulted in clinical success in 81% of patients. Complication rates in geriatric patients were lower than previously reported in the literature.

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