Assessment and Management of Cervical Spine Injury in Head Injury Victims: A Tertiary Care Center Experience

Abstract

Introduction Cervical spine injury is the common missed finding during the head injury. As the victims of the same will be unconscious in most occasions, clinical evaluation is difficult and we need to rely on investigation as well as clinical examination. It is important to rule out and manage appropriately to attain the proper outcome. Patients and Methods Patients with head injury who were less than GCS 8 and clinical evidence of spinal injuries were added in this study at a tertiary trauma care center at South India for past 4 years. Patients were screened with CT C spine along with CT head on initial evaluation. Any evidence of cervical spinal injury in both imaging and/or clinical examination underwent MRI spine. Treatment initiated appropriately. In a series of 524 patients with GCS less than 8 from May 2010 to May 2014, 74 patients underwent MRI spine based on CT C spine and clinical examination pertaining to cervical spine injury. Patients with thoracic and lumbar spinal injuries were excluded from the study. Follow-up made through clinical visits and telephonic enquiry. Results A total of 47 patients had evidence of cervical spine injury in the form of contusions, altered signal changes, spinal stable and unstable fractures, and ligamentous injury. All patients received appropriate treatment including spinal fixation and continuous rehabilitation. Overall, 19 patients presented with unstable spinal fracture which needs stabilization. Overall, eight patients had extensive spinal cord contusions or altered signal changes. Overall, 17 patients had disc bulges or ligamentous injuries with cord signal changes. Overall, two patients had epidural hematoma. Conclusion Assessment and diagnosing the cervical spine injury is a real challenge in severe head injury victims. Strict protocol and appropriate management are the key to the success for the proper outcome. CT C spine and clinical examination during the initial evaluation help in attaining the goal and in early decision making.