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.

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.

Recovery of Nerve Root Function after Complete Quadriplegia from Cervical Spine Fractures

Neurosurgery ◽  
1986 ◽  
Vol 19 (5) ◽  
pp. 809-812 ◽  
Author(s):  
C. Benzel Edward ◽  
J. Larson Sanford
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Nerve Root ◽  
Root Function ◽  
Spine Fractures ◽  
Anterior Decompression ◽  
Cord Injury ◽  
Nerve Root Decompression ◽  
Anterior Decompression And Fusion ◽  
Cervical Spine Fractures

Abstract Thirty-five patients with complete myelopathies secondary to cervical spine fractures from C-4 to C-7 underwent spinal decompressions and fusions between 1975 and 1981. Twenty-five of these patients underwent simultaneous nerve root decompressions, 23 with an accompanying anterior decompression and fusion and 2 with an accompanying posterior fusion. Substantial recovery of nerve root function occurred in 15 of these patients. A posterior reduction and fusion without nerve root decompression was performed in each of the remaining 10 patients. None of these patients demonstrated a significant improvement neurologically. Operation for nerve root decompression is indicated in selected victims of spinal cord injury.

scholarly journals Risk factors of neurological lesions in low cervical spine fractures and dislocations

2000 ◽  
Vol 58 (4) ◽  
pp. 1030-1034 ◽  
Author(s):  
DANILO GONÇALVES COELHO ◽  
ALBERT V. B. BRASIL ◽  
NELSON PIRES FERREIRA
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Spinal Cord Injuries ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Spine Fractures ◽  
Nerve Root Injury ◽  
Cord Injury ◽  
Cervical Spine Fractures

Eighty-nine patients with lower cervical spine fractures or dislocations were evaluated for risk factors of neurological lesion. The age, sex, level and pattern of fracture and sagittal diameter of the spinal canal were analysed. There were no significant differences on the age, gender, level and Torg's ratio between intact patients and those with nerve root injury, incomplete or complete spinal cord injuries. Bilateral facet dislocations and burst fractures are a significant risk factor of spinal cord injury.

scholarly journals Comparative effectiveness of surgical versus nonoperative management of unilateral, nondisplaced, subaxial cervical spine facet fractures without evidence of spinal cord injury

2014 ◽  
Vol 20 (3) ◽  
pp. 270-277 ◽  
Author(s):  
Bizhan Aarabi ◽  
Stuart Mirvis ◽  
Kathirkamanthan Shanmuganathan ◽  
Alexander R. Vaccaro ◽  
Cassandra J. Holmes ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Cervical Spine ◽  
Motor Vehicle ◽  
Nonoperative Management ◽  
Fracture Plane ◽  
Lateral Mass ◽  
Subaxial Cervical Spine ◽  
Cord Injury ◽  
The Mean ◽  
Stage 1

Object Facet joints are major stabilizers of cervical motion allowing for effortless and pain-free multidimensional cervical spine movements without significant linear or rotational translation, thus minimizing any chance for spinal cord or nerve root impingement. Unilateral, nondisplaced subaxial facet fractures do not meet the conventional criteria for spinal instability under physiological loads. Limited evidence indicates that even with no or minimal displacement, 20%–80% of these fractures fail nonoperative management. The risk factors for instability in isolated nondisplaced subaxial facet fractures remain uncertain. In this retrospective study of prospectively collected data, the authors attempted to identify the predictors of failure in the management of isolated, nondisplaced subaxial facet fractures admitted to their Level I trauma center over a 10-year period. Methods Demographic, clinical, imaging, and follow-up data for 25 patients with unilateral nondisplaced subaxial facet fractures who were managed surgically (n = 10) or nonoperatively (n = 15) were statistically analyzed. Results The mean age of the patients was 38 years, 19 were male, and 21 of the fractures were the result of either motor vehicle accidents or falls. The mean motor score on the American Spinal Injury Association scale was 99.2, and the mean Subaxial Injury Classification (SLIC) severity score was 3 (operated 3.5, nonoperated 2.3). Allen mechanistic classification included 22 compressive-extension Stage 1 and 2 distractive-extension Stage 1 fractures. Subaxial facet fractures involved C-7 in 17 patients (68%), C-6 in 7 (28%), and C-3 in 1 (4%). The anatomical plane of fracture through the lateral mass was sagittal in 12 patients, axial in 8, and coronal in 3 patients. Nondisplaced floating lateral mass injuries were noted in 2 patients. The mean instability score, considering 7 components of the discoligamentous complex on MRI, was 3.2 (operated 3.6, nonoperated 3.0). Ten (40%) of 25 patients in this investigation did not have successful management, 9 in the nonoperated and 1 in the operated group (p = 0.018). Unsuccessful management was significantly greater in younger patients (p = 0.0008), possibly indicating selection bias (p = 0.07, Wilcoxon ranksum test). Fracture plane, instability, and SLIC scores did not play a significant role in treatment failure in this study. Conclusions In this study, surgery was superior to nonoperative management of isolated, nondisplaced, or minimally displaced subaxial cervical spine facet fractures.

Health care burden of cervical spine fractures in the United States: analysis of a nationwide database over a 10-year period

2010 ◽  
Vol 13 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Ali A. Baaj ◽  
Juan S. Uribe ◽  
Tann A. Nichols ◽  
Nicholas Theodore ◽  
Neil R. Crawford ◽  
...  
Keyword(s):  
Health Care ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Cervical Spine ◽  
Adverse Outcomes ◽  
Spine Fractures ◽  
Cord Injury ◽  
The Us ◽  
Discharge Status ◽  
Cervical Spine Fractures

Object The objective of this work was to search a national health care database of patients diagnosed with cervical spine fractures in the US to analyze discharge, demographic, and hospital charge trends over a 10-year period. Methods Clinical data were derived from the Nationwide Inpatient Sample (NIS) for the years 1997 through 2006. The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20% random stratified sample of all discharges from nonfederal hospitals within the US. Patients with cervical spine fractures with and without spinal cord injury (SCI) were identified using the appropriate ICD-9-CM codes. The volume of discharges, length of stay (LOS), hospital charges, total national charges, discharge pattern, age, and sex were analyzed. National estimates were calculated using the HCUPnet tool. Results Approximately 200,000 hospitalizations were identified. In the non-SCI group, there was a 74% increase in hospitalizations and charges between 1997 and 2006, but LOS changed minimally. There was no appreciable change in the rate of in-hospital mortality (< 3%), but discharges home with home health care and to skilled rehabilitation or nursing facilities increased slightly. In the SCI group, hospitalizations and charges increased by 29 and 38%, respectively. There were no significant changes in LOS or discharge status in this group. Spinal cord injury was associated with increases in LOS, charges, and adverse outcomes compared with fractures without SCI. Total national charges associated with both groups combined exceeded $1.3 billion US in 2006. Conclusions During the studied period, increases in hospitalizations and charges were observed in both the SCI and non-SCI groups. The percentage increase was higher in the non-SCI group. Although SCI was associated with higher adverse outcomes, there were no significant improvements in immediate discharge status in either group during the 10 years analyzed.

“Proximalization is Advancement”—Zone 3 Frozen Elephant Trunk vs Zone 2 Frozen Elephant Trunk: A Literature Review

2021 ◽  
pp. 153857442110024
Author(s):  
Rozina Yasmin Choudhury ◽  
Kamran Basharat ◽  
Syeda Anum Zahra ◽  
Tien Tran ◽  
Lara Rimmer ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Surgical Treatment ◽  
Literature Review ◽  
Treatment Options ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Cord Injury ◽  
Aortic Pathologies

Over the decades, the Frozen Elephant Trunk (FET) technique has gained immense popularity allowing simplified treatment of complex aortic pathologies. FET is frequently used to treat aortic conditions involving the distal aortic arch and the proximal descending aorta in a single stage. Surgical preference has recently changed from FET procedures being performed at Zone 3 to Zone 2. There are several advantages of Zone 2 FET over Zone 3 FET including reduction in spinal cord injury, visceral ischemia, neurological and cardiovascular sequelae. In addition, Zone 2 FET is a technically less complicated procedure. Literature on the comparison between Zone 3 and Zone 2 FET is scarce and primarily observational and anecdotal. Therefore, further research is warranted in this paradigm to substantiate current surgical treatment options for complex aortic pathologies. In this review, we explore literature surrounding FET and the reasons for the shift in surgical preference from Zone 3 to Zone 2.

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