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.

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.

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.

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.

Risk of early closed reduction in cervical spine subluxation injuries

1999 ◽  
Vol 90 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Gerald A. Grant ◽  
Sohail K. Mirza ◽  
Jens R. Chapman ◽  
H. Richard Winn ◽  
David W. Newell ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Mr Imaging ◽  
Disc Herniation ◽  
Closed Reduction ◽  
Spinal Cord Injuries ◽  
Spinal Injury ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Content Type ◽  
Fine Print

Object. The authors retrospectively reviewed 121 patients with traumatic cervical spine injuries to determine the risk of neurological deterioration following early closed reduction. Methods. After excluding minor fractures and injuries without subluxation, the medical records and imaging studies (computerized tomography and magnetic resonance [MR] images) of 82 patients with bilateral and unilateral locked facet dislocations, burst fractures, extension injuries, or miscellaneous cervical fractures with subluxation were reviewed. Disc injury was defined on MR imaging as the presence of herniation or disruption: a herniation was described as deforming the thecal sac or nerve roots, and a disruption was defined as a disc with high T2-weighted signal characteristics in a widened disc space. Fifty-eight percent of patients presented with complete or incomplete spinal cord injuries. Thirteen percent of patients presented with a cervical radiculopathy, 22% were intact, and 9% had only transient neurological deficits in the field. Early, rapid closed reduction, using serial plain radiographs or fluoroscopy and Gardner—Wells craniocervical traction, was achieved in 97.6% of patients. In two patients (2.4%) closed reduction failed and they underwent emergency open surgical reduction. The average time to achieve closed reduction was 2.1 ± 0.24 hours (standard error of the mean). The incidence of disc herniation and disruption in the 80 patients who underwent postreduction MR imaging was 22% and 24%, respectively. However, the presence of disc herniation or disruption did not affect the degree of neurological recovery, as measured by American Spinal Injury Association motor score and the Frankel scale following early closed reduction. Only one (1.3%) of 80 patients deteriorated, but that occurred more than 6 hours following closed reduction. Conclusions. Although disc herniation and disruption can occur following all types of traumatic cervical fracture subluxations, the incidence of neurological deterioration following closed reduction in these patients is rare. The authors recommend early closed reduction in patients presenting with significant motor deficits without prior MR imaging.

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.

scholarly journals Determination of Early Neurological Outcome by ASIA score following Delayed Anterior Decompression and Stabilization of Lower Cervical Spine Injury

2018 ◽  
Vol 4 (2) ◽  
pp. 82-86
Author(s):  
Mohammed Ashraful Haque ◽  
SK Sader Hossain ◽  
Md Mahfuzur Rahman ◽  
Md Rafiqul Islam ◽  
Sadika Kadir ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neurological Outcome ◽  
Cervical Spine Injury ◽  
Spinal Injury ◽  
Donor Site ◽  
Csf Leak ◽  
Spine Injury ◽  
Lower Cervical Spine ◽  
Anterior Decompression ◽  
Cross Sectional

Background: Surgical management of lower cervical spine injury is a very important issue among these patients. Objective: The purpose of the present study was todetermine the early neurological outcome of delayed anterior decompression and stabilization of lower cervical spine injury. Methodology: This cross sectional study was carried out in the Department of Neurosurgery at Dhaka Medical College and Hospital, Dhaka, Bangladesh within the period of January 2010 to July 2011 for a period of one year and 6 months. Neurological outcome following anterior decompression and stabilization of lower cervical spine injury was observe. Patients presented with lower cervical spine injury were included in this prospective study. Quantification of neurologic deficit in lower cervical spine injury patients were carried out by following The American Spinal Injury Association (ASIA) impairment scale. Early neurological outcome was also assessed after operation by using ASIA impairment scale in the follow up period at one, three and six months interval. Result: A total of 31 patients were included in this study. Based on the ASIA impairment scale, preoperatively, 6.4 5% of the injuries were grade A, 16.13 % of the injuries were Grade B, 16.13% of the injuries were Grade C and 35.48 % of the injuries were Grade D. early post-operative complications include dysphagia in 3 5.48% cases, donor site infection in 9.67% cases, CSF leak in 3.22%; catheter related urinary tract infection 9.67% and bed sore occurred in 6.45% cases. Conclusion: In conclusion significant neurological recovery can be expected following delayed anterior decompression and stabilization of lower cervical spine in lower cervical spine injury patient. Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 82-86

scholarly journals Have changes in computerised tomography guidance positively impacted detection of cervical spine injury in children? A review of the Trauma Audit and Research Network data

Trauma ◽  
2020 ◽  
pp. 146040862093938
Author(s):  
Catherine Nunn ◽  
Samantha Negus ◽  
Tomas Lawrence ◽  
Fiona Lecky ◽  
Damian Roland
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Major Trauma ◽  
Spinal Injury ◽  
Clinical Care ◽  
Research Network ◽  
Spine Injury ◽  
Computerised Tomography ◽  
Trauma Centres ◽  
Reported Data

Background Clinically significant damage to the cervical spine in children is uncommon, but missing this can be life-changing for patients. The balance between rarity and severity leads to inconsistent scanning, with both resource and radiation implications. In 2014, the United Kingdom’s National Institute for Health and Care Excellence updated their computerised tomography neck imaging guidance in children. The aim of this study was to assess if the change in guidance had resulted in a change in diagnosis or imaging rates. Methods A retrospective review of the national Trauma Audit and Research Network’s data for computerised tomography spine imaging in children in 2012–2013 was compared to the same data sample collected in 2015–2016. Results The percentage of children presenting with neck trauma who were imaged reduced from 15.5 to 14.1% with an increase in confirmed cervical spine injury from 1.6 to 2.3% between the two time periods. The specificity of computerised tomography scanning increased from 10 to 16.4%. There was variation in scan rates, with major trauma centres scanning a greater percentage of children of all ages and with all injury scores, than trauma units. Discussion This study suggests national guidance can impact clinical care in a relatively short timeframe. Variation in how guidance is applied, with major trauma centres scanning proportionately more children with a lower yield, could be because scanning is more readily available, or because trauma protocols encourage more scans. Twenty per cent of injuries were not found on the initial computerised tomography, in keeping with previously reported data, because the injuries were ligamentous or cord contusion. This suggests a role for early magnetic resonance imaging in children with suspected spinal injury.

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