scholarly journals C1-C2 Subluxation after Mild Cervical Spine Trauma in a Child

2020 ◽  
pp. 1-3
Author(s):  
Isabel Snee ◽  
Isabel Snee ◽  
Catherine A. Mazzola
Keyword(s):  
Cervical Spine ◽  
Head Tilt ◽  
Spine Injury ◽  
Halo Traction ◽  
Cord Injury ◽  
Magnetic Resonance Imaging Mri ◽  
Cervical Spine Alignment ◽  
Atlanto Axial Joint ◽  
Spine Radiographs ◽  
Halo Device

We report a case of a seven-year-old girl who presented with a “Cock-Robin” head tilt and cervical spine injury after falling from her bed. Initial cervical spine X-ray reported a fractured clavicle. However, almost four weeks later, the torticollis had not resolved. Computerized tomography (CT) of the cervical spine revealed subluxation of the atlanto-axial joint at C1-C2. Cervical spine magnetic resonance imaging (MRI) did not show any spinal cord injury. Manual reduction and hard collar placement were attempted, yet C1- C2 subluxation recurred. The child was placed into halo traction and then into a halo vest. CT scan showed near complete resolution of C1-C2 subluxation. Three months later the halo device was removed, and the patient was placed in a hard cervical collar then transitioned into a soft collar over a four month period. During this time, the patient received physical therapy. Final cervical spine radiographs revealed proper cervical spine alignment and resolution of C1-C2 subluxation.

scholarly journals Lacrosse Equipment and Cervical Spinal Cord Space During Immobilization: Preliminary Analysis

2010 ◽  
Vol 45 (1) ◽  
pp. 39-43 ◽  
Author(s):  
Michael Higgins ◽  
Ryan T. Tierney ◽  
Jeffrey B. Driban ◽  
Steven Edell ◽  
Randall Watkins
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Repeated Measures ◽  
Cervical Spinal Cord ◽  
Spine Injury ◽  
Imaging Center ◽  
Mri Scans ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Cervical Spine Alignment

Abstract Context: Removal of the lacrosse helmet to achieve airway access has been discouraged based only on research in which cervical alignment was examined. No researchers have examined the effect of lacrosse equipment on the cervical space available for the spinal cord (SAC). Objective: To determine the effect of lacrosse equipment on the cervical SAC and cervical-thoracic angle (CTA) in the immobilized athlete. Design: Observational study. Setting: Outpatient imaging center. Patients or Other Participants: Ten volunteer lacrosse athletes (age  =  20.7 ± 1.87 years, height  =  180.3 ± 8.3 cm, mass  =  91 ± 12.8 kg) with no history of cervical spine injury or disease and no contraindications to magnetic resonance imaging (MRI). Intervention(s): The lacrosse players were positioned supine on a spine board for all test conditions. An MRI scan was completed for each condition. Main Outcome Measure(s): The independent variables were condition (no equipment, shoulder pads only [SP], and full gear that included helmet and shoulder pads [FG]), and cervical spine level (C3–C7). The dependent variables were the SAC and CTA. The MRI scans were evaluated midsagittally. The average of 3 measures was used as the criterion variable. The SAC data were analyzed using a 3 × 5 analysis of variance (ANOVA) with repeated measures. The CTA data were analyzed with a 1-way repeated-measures ANOVA. Results: We found no equipment × level interaction effect (F3.7,72  =  1.34, P  =  .279) or equipment main effect (F2,18  =  1.20, P  =  .325) for the SAC (no equipment  =  5.04 ± 1.44 mm, SP  =  4.69 ± 1.36 mm, FG  =  4.62 ± 1.38 mm). The CTA was greater (ie, more extension; critical P  =  .0167) during the SP (32.64° ± 3.9°) condition than during the no-equipment (25.34° ± 2.3°; t9  =  7.67, P  =  .001) or FG (26.81° ± 5.1°; t9  =  4.80, P  =  .001) condition. Conclusions: Immobilizing healthy lacrosse athletes with shoulder pads and no helmets affected cervical spine alignment but did not affect SAC. Further research is needed to determine and identify appropriate care of the lacrosse athlete with a spine injury.

scholarly journals Hoarseness After Shoulder Surgery in Beach-chair Position

2021 ◽  
Author(s):  
Seung-Min Youn ◽  
Sung-Min Rhee ◽  
Hwan Jin Kim ◽  
Hyun Woo Lee ◽  
Seong Cheol Moon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Vocal Cord ◽  
Recovery Time ◽  
Shoulder Surgery ◽  
Worst Case ◽  
Beach Chair Position ◽  
Cord Injury ◽  
Spine Radiographs ◽  
Beach Chair

Abstract Background Isolated vocal cord palsy resulting hoarseness after shoulder surgery in beach-chair position had not been reported in literature to date. The purpose of this study was to review its incidence in our patient cohort, and identify any risk factors that may predispose the patient to the injury.Methods There were 10215 operative shoulder cases from January 2010 to December 2017. Inclusion criteria was any post-operative patients, whose operation was performed under general anesthesia in beach-chair position, who had the related symptoms, but the diagnoses had to be confirmed by otorhinolaryngologists with laryngoscopy studies. The affected patients’ clinical notes were retrospectively reviewed with the particular interest in the operative times, and the peri-operative cervical spine radiographs. The degree of cervical spine lordosis was assessed using a method described in literature, in which ‘absolute rotation angle’ (ARA) was measured. Results There were 8 reported cases of vocal cord injury in total (0.08%). Four were male patients and four were arthroscopic cases. The mean age was 59.4 ± 11.9 years old. No particular difficulties with positioning or intubation were documented. The average duration of anesthetic times was 141 minutes. On peri-operative cervical spine radiographs, the average lordosis was 8.2° (1.5° kyphosis - 21° lordosis), and except for one patient, all had ‘non-lordotic’ type curvatures. All but one patient had recovered fully with observation and expectant management, with the average recovery time being 19 weeks (range: 2 weeks to 1 year). Only patient who had not recovered during our 2-year follow-up period, had a ‘sigmoidal’ type cervical spine and was also managed with observation only.Conclusions The incidence of vocal cord injury with beach-chair positioning at our institution was low at 0.08%. The possible risk factors include long duration of the procedure and ‘non-lordotic’ cervical spine, as demonstrated by the trend in our study. Although rare, vocal cord injury has varying duration of recovery time, in the worst-case scenario being permanent, therefore it needs to be avoided by taking utmost care during positioning of the patient in beach-chair. Level of Evidence Level IV, case series

scholarly journals Overview of Subaxial Cervical Spine Fractures and Dislocations

2021 ◽  
pp. 235-241
Author(s):  
AbdulWahab Ahmed Alzahrani ◽  
Mohammad Saeed M. Al Fehaid ◽  
Abdullah Saleh A. Alaboudi ◽  
Mohammed Ahmed Abed I. Abualsaoud ◽  
Faisal Abdulmohsen A. Bintalib ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Treatment Options ◽  
Axial Skeleton ◽  
Subaxial Cervical Spine ◽  
Cord Injury ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Normal Shape ◽  
Cervical Spine Fractures

Injuries of the subaxial cervical spine are among the most common and potentially most devastating injuries involving the axial skeleton. The lower cervical spine can suffer minor bony or ligamentous injury that nevertheless results in severe neurologic injury. Plain radiography, computed tomography (CT) scans, and magnetic resonance imaging (MRI) scans are all part of the standard imaging regimen. The delayed timing of dislocation reduction and cost-effectiveness are two issues with routine use of MRI in the diagnosis of cervical facet dislocations. Serval treatment options and approaches can be used. However Orthopedic treatment can be used to reduce the fracture or dislocation returns the vertebral canal to its normal shape and dimensions and decompresses the spinal cord. Immediate treatment should be started if there are signs of spinal cord injury or any factor that could lead to such injuries. In this review we will be looking at epidemiology, causes, evaluation and treatment of such cases.

Neck Injury

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.

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 Return to Play after Cervical Spine Injuries: A Consensus of Opinion

2016 ◽  
Vol 6 (8) ◽  
pp. 792-797 ◽  
Author(s):  
John C. France ◽  
Michael Karsy ◽  
James S. Harrop ◽  
Andrew T. Dailey
Keyword(s):  
Decision Making ◽  
Cervical Spine ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Return To Play ◽  
Spine Injury ◽  
Cervical Cord ◽  
Clinical Scenarios ◽  
Cord Injury

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant. Results Evaluation of the surgeons’ responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology. Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.

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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