Treatment of Cervical Spine Injuries

Abstract

Injuries to the cervical spine (CS) require differential diagnosis and effective therapy. The expected incidence of cervical spine injuries within the Federal Republic of Germany amounts to over 2 000 cases annually. The most serious complication, paraplegia as a result of damage to the cervical spinal cord, occurs in approx. 600 of these cases. Diagnosis, making indications for conservative treatment or surgery, performing technically demanding surgery - usually with special instruments - and perioperative management represent the core tasks of CS injury management, particularly with regard to the treatment of patients with cervical spinal cord injuries. In view of the incidence of secondary injuries in more than 50 % of cases and the incidence of multiple trauma in around 10 % of cases, it is imperative that patients receive treatment in a specialist trauma clinic. The objective of (surgical) treatment is to stabilise the injured motion elements securely, in conjunction with restoring normal anatomy in order to preserve function and prevent secondary neurological damage. In around 20 % of cases, immobilisation is achieved by means of cervical collars or halo fixators. Surgery is chosen in 80 % of cases. The most frequent treatment performed on the upper CS is direct screw fixation of the dens and, on the lower CS, ventral spondylodesis. Dorsal approaches with occipitocervical spondylodesis are rarely used with regard to the upper CS, and osteosynthesis with screws, plates or cerclage is rarely used on the lower CS. Access-related complications affecting the cervical viscera, nerves and vessels are rare. Neurological deterioration is rarely observed. Due to the numerous possible complications associated with the treatment of cervical spinal cord injuries, it is imperative that these patients be transferred to a clinic specialising in spine injuries as soon as possible.