Cervical spinal injury: experience with 82 cases

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A retrospective study of 82 cases of cervical spinal injury was made. These patients were treated in Dhaka Medical College Hospital, Mitford Hospital, Dhaka, and in some private hospitals in Dhaka City during the last 10 years from January 1991 to December 2000. Sixty-eight patients (82.92%) were between 21 and 50 years of age. Male and female ratio was almost 6:1. The most common cause of cervical spinal injury was a fall (53.65%), which was followed by road traffic accident (24.39%). The most common presenting symptoms and signs were: pain in the neck in all cases, quadriplegia/quadriparesis in 56 (68.29%), temporary loss of consciousness in 20 (24.39%) and sphincter disturbances in 48 (58.53%) patients. Twenty-six (31.70%) cases were free from neurological deficit. Plain X-ray cervical spine was done in all cases. Radiological evidence was found of cervical spinal injury in all but six cases (7.31%). Cervical myelogram was done in 12 (14.63%) cases and MRI of the cervical spine was done in 24 (29.27%) patients. Commonly affected sites of cervical spinal injury were found at C4/C5 and C5/C6 levels (43.92%). Forty-three (52.45%) cases were treated conservatively by Tong Skull traction and immobilization, and 39 (47.55%) were operated upon. Anterior fusion was done in 25 cases (30.49%) and posterior fusion in 10 (12.19%). Results of treatment were: full recovery in 30 patients (36.57%), good recovery in 16 (19.52%), partial recovery in 26 (31.71%) and no change in neurological state in 6 (7.32%). Recurrence of dislocation and consequent neural compression was found in six (7.32%) cases of the conservative treatment group of patients. Mortality was three (3.66%), also in the nonoperative group of patients. It was seen that there were better treatment results in cases of surgical fusion in unstable cervical injury, and there was a chance of instability and delayed loss of neurological function in conservative treatment of unstable cervical spinal injury, which needed subsequent surgical fusion.