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.

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.

scholarly journals Motorcycle helmets and cervical spine injuries: a 5-year experience at a Level 1 trauma center

2018 ◽  
Vol 28 (6) ◽  
pp. 607-611 ◽  
Author(s):  
Paul S. Page ◽  
Zhikui Wei ◽  
Nathaniel P. Brooks
Keyword(s):  
Cervical Spine ◽  
Trauma Center ◽  
Cervical Spine Injury ◽  
Spine Fracture ◽  
Spine Injury ◽  
Cervical Spine Fracture ◽  
Helmet Use ◽  
Level 1 ◽  
Motorcycle Helmets ◽  
Level 1 Trauma Center

OBJECTIVEMotorcycle helmets have been shown to decrease the incidence and severity of traumatic brain injury due to motorcycle crashes. Despite this proven efficacy, some previous reports and speculation suggest that helmet use is associated with a higher likelihood of cervical spine injury (CSI). In this study, the authors examine 1061 cases of motorcycle crash victims who were treated during a 5-year period at a Level 1 trauma center to investigate the association of helmet use with the incidence and severity of CSI. The authors hypothesized that wearing a motorcycle helmet during a motorcycle crash is not associated with an increased risk of CSI and may provide some protective advantage to the wearer.METHODSThe authors performed a retrospective review of all cases in which the patient had been involved in a motorcycle crash and was evaluated at a single Level 1 trauma center in Wisconsin between January 1, 2010, and January 1, 2015. Biometric, clinical, and imaging data were obtained from a trauma registry database. The patients were then divided into 2 distinct groups based on whether or not they were wearing helmets at the time of the accident. Baseline and functional characteristics were compared between the 2 groups. The Student t-test was used for continuous variables, and Pearson’s chi-square analysis was used for categorical variables.RESULTSIn total, 1061 patient charts were examined containing data on 738 unhelmeted (69.6%) and 323 helmeted (30.4%) motorcycle riders. On average, helmeted riders had a much lower Injury Severity Score (p < 0.001). Cervical spine injury occurred in 114 unhelmeted riders (15.4%) compared with only 24 helmeted riders (7.4%) (p < 0.001), with an adjusted odds ratio of 2.3 (95% CI 1.44–3.61, p = 0.0005). In the unhelmeted group, 10.8% of patients were found to have a cervical spine fracture compared with only 4.6% of patients in the helmeted group (p = 0.001). Additionally, ligamentous injury occurred more frequently in unhelmeted riders (1.9% vs 0.3%, p = 0.04). No difference was found in the occurrence of cervical strain, cord contusion, or nerve root injury (all p > 0.05).CONCLUSIONSThe results of this study demonstrate a statistically significant lower likelihood of suffering a CSI among helmeted motorcyclists. Unhelmeted riders sustained a statistically significant higher number of vertebral fractures and ligamentous injuries. The study findings reported here confirm the authors’ hypothesis that helmet use does not increase the risk of developing a cervical spine fracture and may provide some protective advantage.

Surgical stabilization of traumatic cervical spine dislocation using methyl methacrylate

1986 ◽  
Vol 64 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Thomas A. Duff
Keyword(s):  
Cervical Spine ◽  
Methyl Methacrylate ◽  
Neurological Impairment ◽  
Spine Fracture ◽  
Cervical Spine Fracture ◽  
Content Type ◽  
Spinal Stabilization ◽  
Stainless Steel Screw ◽  
Fracture Dislocations

✓ Twenty-six patients with traumatic cervical spine fracture-dislocations had spinal stabilization with methyl methacrylate (acrylic) as the primary support. In most cases a ¾-in. stainless steel screw was inserted into the articular pillars of the fractured vertebra and of the two adjacent vertebrae, followed by application of the acrylic in the form of an oblong mold over the heads of the screws. The follow-up period in these 26 patients ranged from 6 months to 7 years. There were no instances of wound infection or increased neurological impairment. Vertebral elements remained aligned in 25 of the 26 patients. Breakage of the acrylic support was documented in two patients, but in only one was surgical repair required. The results of this study indicate that the procedure is a safe and effective method for both immediate and long-term stabilization of cervical spine fracture-dislocations.

Vertebral artery injury associated with cervical spine fracture dislocation

2016 ◽  
Vol 16 (8) ◽  
pp. e529-e530
Author(s):  
Cahit Kafadar ◽  
Onur Levent Ulusoy ◽  
Ersin Ozturk ◽  
Ayhan Mutlu
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Spine Fracture ◽  
Fracture Dislocation ◽  
Vertebral Artery Injury ◽  
Cervical Spine Fracture ◽  
Artery Injury

scholarly journals Upper Cervical Spine Fracture-Dislocation in Patients With Ankylosing Spondylitis: Application of Halo Vest Before and During Posterior Surgery

2021 ◽  
Author(s):  
Haisong Yang ◽  
Yuling Sun ◽  
Liang Wang ◽  
Chunyan Gao ◽  
Fengbin Yu ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Ankylosing Spondylitis ◽  
Spine Fracture ◽  
Fracture Dislocation ◽  
Cervical Spine Fracture ◽  
Upper Cervical Spine ◽  
Halo Vest ◽  
Posterior Surgery ◽  
Upper Cervical

Abstract Background It is a challenge to reduce and immobilize the broken “bamboo spine”, especially for the upper cervical spine, in patients with ankylosing spondylitis (AS) before and during posterior surgery. Methods We retrospectively analyzed the case histories, operations, neurologic outcomes, follow-up data, and imaging records of 17 patients with AS and upper cervical spine fracture-dislocation who underwent surgical treatment in three clinical spine center from 2010 to 2019. A halo vest was used to reduce and immobilize fractured spinal column ends. The neurological injury was evaluated using the American Spinal Injury Association (ASIA) impairment scale score and Japanese Orthopaedic Association (JOA) score before and after operation. Complications and time of bone fusion were recorded. Results Fourteen patients achieved closed anatomical reduction after halo vest application. No displacement in fracture ends and loss of reduction occurred after prone position. No patient presented with secondary neurological deterioration. All patients was performed posterior surgery. The surgery improved the ASIA grade in all patients (P < 0.001). The mean JOA score also increased significantly at last follow-up compared to preoperation (14.5 ± 2.3 vs. 9.2 ± 2.4, P < 0.01). No severe complication and death occurred. All patients reached solid bony fusion at 12-month follow-up. Conclusions Use of a halo vest before and during the operation is safe and effective in patients with AS who develop upper cervical spine fracture-dislocation. This technique makes positioning, awake nasoendotracheal intubation, nursing, and the operation more convenient. It can also provide satisfactory reduction and rigid immobilization and prevent secondary neurologic deterioration. .

scholarly journals Prediction Score for Cervical Spine Fracture in Patients with Traumatic Neck Injury

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Natsinee Athinartrattanapong ◽  
Chaiyaporn Yuksen ◽  
Sittichok Leela-amornsin ◽  
Chetsadakon Jenpanitpong ◽  
Sirote Wongwaisayawan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Cervical Spine ◽  
Spine Fracture ◽  
Prediction Score ◽  
Spine Injury ◽  
Cervical Spine Fracture ◽  
Clinical Prediction ◽  
Computed Tomography Scan ◽  
Tomography Scan

Background. Cervical spine fracture is approximately 2%–5%. Diagnostic imaging in developing countries has several limitations. A computed tomography scan is not available 24 hours and not cost-effective. This study aims to develop a clinical tool to identify patients who must undergo a computed tomography scan to evaluate cervical spine fracture in a noncomputed tomography scan available hospital. Methods. The study was a diagnostic prediction rule. A retrospective cross-sectional study was conducted between August 1, 2016, and December 31, 2018, at the emergency department. This study included all patients aged over 16 years who had suspected cervical spine injury and underwent a computed tomography scan at the emergency department. The predictive model and prediction scores were developed via multivariable logistic regression analysis. Results. 375 patients met the criteria. 29 (7.73%) presented with cervical spine fracture on computed tomography scan and 346 did not. Five independent factors (i.e., high-risk mechanism of injury, paraparesis, paresthesia, limited range of motion of the neck, and associated chest or facial injury) were considered good predictors of C-spine fracture. The clinical prediction score for C-spine fracture was developed by dividing the patients into three probability groups (low, 0; moderate, 1–5; and high, 6–11), and the accuracy was 82.52%. In patients with a score of 1–5, the positive likelihood ratio for C-spine fracture was 1.46. Meanwhile, those with a score of 6–11 had an LR+ of 7.16. Conclusion. In a noncomputed tomography scan available hospital, traumatic spine injuries patients with a clinical prediction score ≥1 were associated with cervical spine fracture and should undergo computed tomography scan to evaluate C-spine fracture.

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