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.

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.

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.

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.

Prediction of stability of cervical spine fracture managed in the halo vest and indications for surgical intervention

1990 ◽  
Vol 72 (3) ◽  
pp. 426-432 ◽  
Author(s):  
William Sears ◽  
Mahmood Fazl
Keyword(s):  
Mathematical Model ◽  
Cervical Spine ◽  
Outcome Prediction ◽  
Facet Joint ◽  
Spine Injury ◽  
Halo Vest ◽  
Content Type ◽  
Joint Dislocation ◽  
Unsuccessful Treatment ◽  
Fine Print

✓ A retrospective study was made of 173 cases of acute cervical spine injury with halo vest management to compare initial injury features with outcome. The object was to determine whether a mathematical model could be developed enabling a prediction to be made at the time of the initial assessment as to the probability of success or failure of conservative management using the halo vest alone, and thus perhaps avoid lengthy, unsuccessful treatment. Patients with facet joint dislocation were found to form a distinct subgroup of the injury population. Of the 70 patients in this subgroup, 44% achieved stability with the halo vest alone, but half of these had a “poor anatomical result.” No mathematical model or associated injury features could be found to assist in the outcome prediction in this subgroup. Of the 103 patients without facet joint dislocation, 70% achieved stability with the vest alone and over 75% of these had a “good anatomical result.” A useful model of outcome prediction was found for this subgroup by logistic regression analysis; the two most important predictors in the model were the amount of subluxation and the degree of angulation in the sagittal plane.

A comparison of the Minerva and halo jackets for stabilization of the cervical spine

1989 ◽  
Vol 70 (3) ◽  
pp. 411-414 ◽  
Author(s):  
Edward C. Benzel ◽  
Theresa A. Hadden ◽  
Carla M. Saulsbery
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Substantial Improvement ◽  
Spine Injury ◽  
Content Type ◽  
Closed Cell ◽  
Ambulatory Patients ◽  
Intervertebral Level ◽  
Unstable Cervical Spine ◽  
Cell Foam

✓ The motion at each intervertebral level permitted by the halo jacket and the thermoplastic Minerva body jacket was compared in 10 ambulatory patients with an unstable cervical spine. The thermoplastic Minerva body jacket is a new lightweight modification of a Minerva jacket which is fabricated from Polyform (a splinting material made of a polyester polycaprolactone) and Polycushion (a closed-cell foam for padding). Each patient served as his/her own control. The average movement from flexion to extension at each intervertebral level was significantly less in the thermoplastic Minerva body jacket (2.3° ± 1.7°) than in the halo jacket (3.7° ± 3.1°) (p < 0.0025). This difference is attributable to the “snaking phenomenon” encountered with halo jacket immobilization and should be taken into account when considering an external splint for an unstable cervical spine. The thermoplastic Minerva body jacket also offered a substantial improvement in comfort for the patient over that experienced in the halo jacket. The apparent advantage with respect to stability and comfort of the thermoplastic Minerva body jacket over the halo jacket suggests that the former device is the orthosis of choice for ambulatory stabilization of most patients with an unstable posttraumatic cervical spine injury.

Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics

2002 ◽  
Vol 96 (3) ◽  
pp. 285-291 ◽  
Author(s):  
Langston T. Holly ◽  
Daniel F. Kelly ◽  
George J. Counelis ◽  
Thane Blinman ◽  
David L. McArthur ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Injury ◽  
Cervical Spine Trauma ◽  
Spine Trauma ◽  
Content Type ◽  
Head Injured ◽  
Cervical Injuries ◽  
Gcs Score ◽  
Injured Patients ◽  
Fine Print

Object. Diagnosing and managing cervical spine trauma in head-injured patients is problematic due to an altered level of consciousness in such individuals. The reported incidence of cervical spine trauma in head-injured patients has generally ranged from 4 to 8%. In this retrospective study the authors sought to define the incidence of cervical injury in association with moderate or severe brain injury, emphasizing the identification of high-risk patients. Methods. The study included 447 consecutive moderately (209 cases) or severely (238 cases) head injured patients who underwent evaluation at two Level 1 trauma centers over a 40-month period. Of the 447 patients, 24 (5.4%) suffered a cervical spine injury (17 men and seven women; mean age 39 years; median Glasgow Coma Scale [GCS] score of 6, range 3–14). Of these 24 patients, 14 (58.3%) sustained spinal cord injuries (SCIs), 14 sustained injuries in the occiput—C3 region, and 10 underwent a stabilization procedure. Of the 14 patients with SCIs, nine experienced an early hypotensive and/or hypoxic insult. Regarding the mechanism of injury, cervical injuries occurred in 21 (8.2%) of 256 patients involved in motor vehicle accidents (MVAs), either as passengers or pedestrians, compared with three (1.6%) of 191 patients with non-MVA-associated trauma (p < 0.01). In the subset of 131 MVA passengers, 13 (9.9%) sustained cervical injuries. Patients with an initial GCS score less than or equal to 8 were more likely to sustain a cervical injury than those with a score higher than 8 (odds ratio [OR] 2.77, 95% confidence interval [CI] = 1.11–7.73) and were more likely to sustain a cervical SCI (OR 5.5, 95% CI 1.22–24.85). At 6 months or more postinjury, functional neurological recovery had occurred in nine patients (37.5%) and eight (33.3%) had died. Conclusions. Head-injured patients sustaining MVA-related trauma and those with an initial GCS score less than or equal to 8 are at highest risk for concomitant cervical spine injury. A disproportionate number of these patients sustain high cervical injuries, the majority of which are mechanically unstable and involve an SCI. The development of safer and more rapid means of determining cervical spine integrity should remain a high priority in the care of head-injured patients.

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.

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