Fracture dislocation of the cervical spine with gross displacement

1975 ◽  
Vol 42 (2) ◽  
pp. 209-211 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Cervical Spine ◽  
Vertebral Body ◽  
Cervical Spine Injury ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Content Type ◽  
Fine Print

✓ A case of cervical spine injury is presented in which complete displacement of one vertebral body was accompanied by only mild quadriparesis.

Magnetic resonance imaging evaluation of the cervical spine in the comatose or obtunded trauma patient

1999 ◽  
Vol 91 (1) ◽  
pp. 54-59 ◽  
Author(s):  
Mark D. D'Alise ◽  
Edward C. Benzel ◽  
Blaine L. Hart
Keyword(s):  
Cervical Spine ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Trauma Patient ◽  
Cervical Spine Injury ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Spine Injury ◽  
Content Type ◽  
Fine Print

Object. Confirmation of cervical spine stability is difficult to obtain in the comatose or obtunded trauma patient. Concurrent therapies such as endotracheal intubation and the application of rigid cervical collars diminish the utility of plain radiographs. Bony as well as supportive soft-tissue structures must be evaluated before the cervical spine can be determined to be uninjured. Although major injuries to extradural soft-tissue structures in the awake trauma patient are frequently excluded by physical examination, when the patient is obtunded the physical examination may be unreliable. Therefore, an enhanced diagnostic method for the evaluation of soft-tissue injury is desirable. The authors conducted a study in which magnetic resonance (MR) imaging was used as such a method to assess posttraumatic spinal stability in the comatose or obtunded patient. Methods. Early, limited (sagittal T1- and T2-weighted) MR imaging was performed posttruama in 121 patients to assess soft-tissue injury. In all patients the mechanism of injury potentially could be associated with cervical spine instability, and each patient was endotracheally intubated because of head injury or severe multisystem injuries. All patients underwent imaging studies within 48 hours of injury and were either treated or cleared and spinal precautions were discontinued. Patients were excluded from this study if they had an obvious cervical spine injury identified on the initial radiographic studies or if they were determined to be too medically unstable to undergo MR imaging within the acute period (<48 hours postinjury). Thirty-one (25.6%) of the 121 patients were found to have sustained significant injury to the paravertebral ligamentous structures, the disc interspace, or the bony cervical spine. These injuries were undetected by plain radiography. The other 90 patients (74.4%) were determined within 48 hours not to have sustained a soft-tissue injury. Eight patients (6.6%) ultimately underwent surgery to treat the cervical spine injury, and MR imaging was the first test that identified the injury in each of these patients. There were no complications related to imaging procedures. Conclusions. Sagittal T1- and T2-weighted MR imaging appears to be a safe, reliable method for evaluating the cervical spine for nonapparent injury in comatose or obtunded trauma patients. In the early postinjury period, nursing and medical care are thereby facilitated for patients in whom occult injury to the spine is ruled out and for whom those attendant precautions are unnecessary.

Preinjury cervical alignment affecting spinal trauma

2002 ◽  
Vol 97 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Dennis J. Maiman ◽  
Narayan Yoganandan ◽  
Frank A. Pintar
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Spinal Injury ◽  
Fracture Pattern ◽  
Spine Injury ◽  
Spinal Alignment ◽  
Initial Alignment ◽  
Content Type ◽  
Head Neck ◽  
Fine Print

Object. The authors tested the hypothesis that initial alignment of the head—neck complex affects cervical spine injury mechanism, trauma rating, injury classification based on stability, and fracture pattern. Methods. Thirty intact human cadaveric head—neck complexes were prepared by fixing the thoracic end in polymethylmethacrylate. The cranium was unconstrained. The initial spinal alignment was described in terms of eccentricity, defined as the anteroposterior position of the occipital condyles with respect to the T-1 vertebral body. The specimens were subjected to impact loading delivered using an electrohydraulic testing device. Outcomes after injury were identified using radiography and computerized tomography. The mechanisms of injury were classified according to fracture pattern into compression—extension, compression—flexion, hyperflexion, and vertical compression. Trauma was graded according to the Abbreviated Injury Scale rating system. Based on clinical assessment, injuries were classified as stable or unstable. Injuries were also classified into bone fracture or nonfracture groups. Analysis of variance tests were used to determine the influence of eccentricity on spinal injury outcomes. Eccentricity significantly influenced the mechanism of injury (p < 0.0001), trauma rating (p < 0.005), and fracture (p < 0.0001) classification. Statistically significant differences, however, were not apparent when the classification of injury was based on stability considerations. Conclusions. Spinal alignment is a strong determinant of the biomechanics of impact-induced cervical spine injury.

Pitfalls of bungee jumping

1998 ◽  
Vol 89 (6) ◽  
pp. 1040-1042 ◽  
Author(s):  
Deon Louw ◽  
Kesava K. V. Reddy ◽  
Carl Lauryssen ◽  
Gideon Louw
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Surgical Intervention ◽  
Spine Injury ◽  
Content Type ◽  
Serious Injury ◽  
Fine Print

✓ A case of cervical spine injury related to bungee jumping is presented. Surgical intervention resulted in resolution of the patient's quadriparesis. The incidence of serious injury connected with this pastime is not inconsiderable, and it is recommended that safer jumping practices be followed. Inspection of bungee equipment and certification of instructors is now voluntary but should be mandated. Jumping heights should be limited and the use of air cushions encouraged.

Spondyloptotic fracture of the cervical spine in a pregnant, anemic Jehovah's Witness: technical and ethical considerations

1997 ◽  
Vol 87 (3) ◽  
pp. 458-463 ◽  
Author(s):  
Frank Feigenbaum ◽  
Daniel P. Sulmasy ◽  
Edmund D. Pellegrino ◽  
Fraser C. Henderson
Keyword(s):  
Cervical Spine ◽  
Medical Center ◽  
Spine Fracture ◽  
Fracture Dislocation ◽  
Spine Injury ◽  
Cervical Spine Fracture ◽  
Content Type ◽  
Jehovah’S Witness ◽  
Jehovah's Witness ◽  
Fine Print

✓ The authors present the case of a 15-year-old Jehovah's Witness with a hematocrit level of 19% who was 4 months pregnant and had a two-level spondyloptotic cervical spine fracture. The patient was transferred to Georgetown University Medical Center with C-5 quadriplegia 3 weeks after having been injured in an automobile collision. The neurosurgical issues in this case included addressing a rare cervical spine injury, assessing and treating a vertebral artery injury, and performing surgery on a pregnant minor with severe anemia who held strong Jehovah's Witness beliefs. An ethics consultation was convened to determine the validity of a pregnant minor's refusal to undergo transfusion on the grounds of her religious beliefs. This case illustrates the potential benefits of thorough technical and ethical evaluations and reveals how they may contribute to the delivery of care in complex neurosurgical cases. To the authors' knowledge, this is the first two-level spondyloptotic cervical spine fracture dislocation to be reported in the literature. The added complexities of the case, given that the patient was an anemic, adolescent, pregnant Jehovah's Witness who refused blood transfusion, also appear to be unprecedented.

Multidirectional tomography in cervical spine injury

1976 ◽  
Vol 45 (1) ◽  
pp. 9-11 ◽  
Author(s):  
Lincoln D. Russin ◽  
Faustino C. Guinto
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Conventional Radiography ◽  
Spine Injury ◽  
Content Type ◽  
Fine Print

✓ Forty-one patients with acute cervical spine injury were examined by both conventional radiography and multidirectional tomography and the findings compared. Indications for tomography are given.

An unusual presentation and resolution of syringomyelia after cervical spine injury

2005 ◽  
Vol 3 (6) ◽  
pp. 482-484 ◽  
Author(s):  
Joseph Cusick ◽  
Zvi Lidar
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Spine Injury ◽  
Type I ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Resonance Imaging ◽  
Chiari Malformation Type I ◽  
Content Type ◽  
Sequence Of Events

✓ The authors describe a case of noncommunicating syringomyelia associated with Chiari malformation Type I in a patient in whom acute symptomatic exacerbation occurred following cervical spine trauma. Surgical stabilization and realignment of the spine resulted in marked resolution of the neurological abnormalities, and subsequent magnetic resonance imaging demonstrated persistent collapse of the syrinx. The authors review the various factors in the pathogenesis of this unusual sequence of events.

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.

Discography and myelography in acute injuries of the cervical spine

1971 ◽  
Vol 35 (5) ◽  
pp. 529-535 ◽  
Author(s):  
Richard B. Raynor
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Fracture Dislocation ◽  
Cervical Fracture ◽  
Content Type ◽  
Relative Safety ◽  
Acute Injuries ◽  
Fine Print

✓ Nineteen patients who suffered trauma to the cervical spine that resulted in moderate to severe neurological deficit were studied by discography. In 15 cases, myelography was also performed. When both tests were done there was good correlation of results. In the four cases where only discography was performed, the lesion was accurately localized. The danger of myelography in acute cervical fracture dislocation is emphasized and the relative safety, ease, and value of discography stressed.

Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury

1996 ◽  
Vol 85 (5) ◽  
pp. 824-829 ◽  
Author(s):  
Edward C. Benzel ◽  
Blaine L. Hart ◽  
Perry A. Ball ◽  
Nevan G. Baldwin ◽  
William W. Orrison ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Magnetic Resonance ◽  
Soft Tissue ◽  
Mr Imaging ◽  
Soft Tissue Injury ◽  
Spine Injury ◽  
Ligamentous Injury ◽  
Radiographic Findings ◽  
Content Type ◽  
Fine Print

✓ Because it is often difficult to diagnose accurately the structurally intact cervical spine after acute trauma, a series of patients was evaluated with magnetic resonance (MR) imaging to assess its efficacy for the evaluation and clearance of the cervical spine in a trauma victim in the early posttrauma period. Ultralow-field MR imaging was used to evaluate 174 posttraumatic patients in whom physical findings indicated the potential for spine injury or minor radiographic findings indicated injury. This series includes only those patients who did not appear to harbor disruption of spinal integrity on the basis of a routine x-ray film. None had clinically obvious injury. Of the 174 patients, 62 (36%) had soft-tissue abnormalities identified by MR imaging, including disc interspace disruption in 27 patients (four with ventral and dorsal ligamentous injury, three with ventral ligamentous injury alone, 18 with dorsal ligamentous injury alone, and two without ventral or dorsal ligamentous injury). Isolated ligamentous injury was observed in 35 patients (eight with ventral and dorsal ligamentous injury, five with ventral ligamentous injury alone, and 22 with dorsal ligamentous injury alone). One patient underwent a surgical fusion procedure, 35 patients (including the one treated surgically) were placed in a cervical collar for at least 1 month, and 27 patients were placed in a thermoplastic Minerva jacket for at least 2 months. All had a satisfactory outcome without evidence of instability. The T2-weighted sagittal images were most useful in defining acute soft-tissue injury; axial images were of minimal assistance. Posttraumatic soft-tissue cervical spine injuries and disc herniations (most likely preexisting the trauma) are more common than expected. A negative MR image should be considered as confirmation of a negative or “cleared” subaxial cervical spine. Diagnostic and patient management algorithms may be appropriately tailored by this information. Thus, MR imaging is useful for early acute posttrauma assessment in a very select group of patients.

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.

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