Cervical Vertebral Fracture Research Articles

Cervical spinal cord injury caused by vertebral body fracture in a patient with concomitant OALL and OPLL

We encountered a case of cervical spinal cord injury associated with cervical vertebral dislocation fracture that occurred in a patient with concomitant ossification of the anterior and posterior longitudinal ligaments. The cervical vertebrae were injured by hyperextension in a car accident. On admission, shearing fracture was noted in the OALL region and vertebral body OPLL region over the posterior column at the fourth cervical level, but no dislocation or neurological findings were noted. Restlessness occurred and caused dislocation several hours after admission, leading to complete injury of the cervical spinal cord. The patient died of complications after 3 weeks. Vertebral body fracture complicated by both OALL and OPLL is very rare, and only four cases have been reported. Since vertebral injury causes delayed fracture/dislocation after a symptom-free interval in cases with ligament ossification, accurate clinical evaluation early after injury and early fixation are necessary.

16-Slice CT angiography (CTA) in patients with suspected blunt carotid and vertebral artery injuries

Conclusion: Multidetector computed tomography angiography (CTA) should supplant digital subtraction angiography (DSA) as a screening modality for patients with possible carotid or vertebral artery injuries after blunt trauma. Summary: Detection of carotid injury after blunt trauma is problematic. With the advent of multidetector CTA and the liberal use of CT scanning in patients with blunt trauma, CTA may serve as a viable alternative to angiography for screening for carotid or vertebral artery injuries after blunt trauma. In this study, the authors sought to determine whether CTA performed with a 16-slice multidetector CT scanner can be used as an initial imagining examination in patients with suspected vertebral artery or carotid blunt injury. Predictive values of clinical variables for screening for carotid or vertebral artery injury were also estimated. This was a retrospective study of patients imaged at a Level 1 trauma center for suspected blunt carotid or vertebral artery injury in 2004. Patients were evaluated by CTA if they met criteria suggestive of possible blunt carotid or vertebral artery injury. These criteria included symptoms or signs of carotid or vertebral artery injury and various injury mechanisms or patterns of injury thought to be associated with an increased risk for carotid or vertebral artery injury. Evaluation included a CTA, and then, at the discretion of the clinical service, DSA was performed to confirm a negative CTA. The primary variable evaluated was the proportion of patients with normal CTAs who also had a normal DSA. There were 372 patients imaged with CTA for suspect carotid or vertebral artery injury. Of these, 271 had normal study results, and 82 (30%) also underwent DSA. DSA was equivocal or normal in 75 of these 82 patients, a 92% negative-predictive value of CTA for carotid or vertebral artery injury (95% confidence interval [CI], 83% to 97%). The positive-predictive value for the clinical screening criteria for carotid or vertebral artery injury was 19% (95% CI, 14% to 23%). Of potential variables predicting carotid or vertebral artery injuries, lateral element cervical vertebral fractures and skull-based fractures were most predictive of a carotid or vertebral artery injury. Comment: Catheter-based angiography should not be routinely required to rule out carotid or vertebral artery injury in 2007. Unfortunately, this study has significant limitations that do not permit such a definitive conclusion. These limitations include the fact not all patients with a negative CTA had DSA; therefore, the negative-predictive value of CTA may either be under-estimated or over-estimated by the study. It is also not possible to determine either the sensitivity or specificity of CTA in detecting carotid or vertebral artery injury. There was no systematic follow-up of patients to assess for late stroke, the end point that really matters. Finally, many trauma centers are now equipped with even more advanced CT scanners, making the results of this study perhaps obsolete even before publication.

Variability in Rates of Arthrodesis Procedures for Patients with Cervical Spine Injuries with and without Associated Spinal Cord Injury

Cervical spine injury, with or without spinal cord injury, is an important cause of morbidity and mortality in the United States. While substantial regional variation has been shown in per capita rates of elective cervical spine surgery, similar data regarding arthrodesis rates for traumatic cervical injury have not been reported, to our knowledge. We assessed the rates of cervical spinal arthrodesis for patients who had a cervical spine injury with or without an associated spinal cord injury. The data for the present study came from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1998 to 2002. International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients with a cervical vertebral fracture or dislocation with or without an associated spinal cord injury. Hospitals were grouped according to their teaching status, location (urban or rural), and volume of cervical spine injury patients. The rates of spinal arthrodesis and halo/tong placement were compared for patients within each diagnostic category. Twenty-eight thousand, five hundred and eighteen patients with a cervical spine injury were analyzed. Spinal arthrodesis was performed for 16.5% of patients who had a cervical fracture without an associated spinal cord injury, for 50.4% of patients who had a cervical spine fracture with an associated spinal cord injury, and for 44.1% of patients who had a cervical dislocation. With the numbers available, the rates of arthrodesis for patients who had a fracture without a spinal cord injury and for patients who had a cervical dislocation were not significantly different between high and low-volume centers, although the rate for patients who had a cervical fracture with a spinal cord injury was significantly higher at high-volume hospitals. The rates of arthrodesis did not vary significantly between urban teaching and nonteaching hospitals, with the numbers available, for patients in any of the three diagnostic categories. Individual hospitals had a threefold to fivefold variation in the arthrodesis rate for patients with a cervical spine injury, depending on the diagnostic category. The present study demonstrated substantial differences in the rate of arthrodesis for patients with cervical spine trauma, depending on the diagnostic category. The variations in the rates of arthrodesis within diagnostic categories appear to be lower than the previously reported variation in the rates of elective cervical spine procedures.

Sixteen-Slice CT Angiography in Patients with Suspected Blunt Carotid and Vertebral Artery Injuries

We sought to determine whether 16-slice multidetector CT angiography (CTA) has sufficient negative predictive value for use as the initial imaging examination for patients with suspected blunt carotid and vertebral artery injury (BCVI) and to estimate the positive predictive value of different screening criteria in assessing BCVI. We conducted a retrospective study of patients who were imaged for suspected BCVI at a Level I trauma center during 2004. The policy at our center was to evaluate all patients with specific indications with CTA, and at the discretion of the clinical service, four-vessel digital subtraction angiography (DSA) if the CTA was normal. We recorded injury grade, location, and diagnostic certainty from the imaging report. The primary outcome was the proportion of patients with normal CTA who also had normal DSA. Of 372 patients imaged with CTA for suspected BCVI, 271 had normal studies. Eighty-two (30%) of those with normal initial CTA were further examined with DSA, which was normal or equivocal in 75 of these 82 patients (CTA negative predictive value, 92% [95% CI, 83% to 97%]). The aggregate positive predictive value of BCVI screening criteria was 19% (95% CI, 14% to 23%). Lateral element cervical vertebral fractures and skull base fractures were the most predictive criteria. Multidetector CTA misses relatively few injuries and adequately supplants DSA as a screening study in patients with risk factors for BCVI. Radiologists should maintain a high degree of suspicion in patients who meet screening criteria. Optimal imaging strategies should focus on the most predictive criteria.

Pattern of Injuries in Fatal Falls from Buildings

When bodies are brought for autopsy it is sometimes unclear whether the injuries are due to a fall from a height or due to blunt trauma from other causes, especially when the bodies are found near buildings with no eyewitnesses available. Studies discussing the injury patterns in adults after falls exclusively from buildings are rare. A five-year retrospective study was carried out on 151 cases of fatal falls from buildings brought for autopsy. The aim was to assess the pattern of these injuries and identify features helpful in discriminating between these and injuries due to blunt trauma from other causes. The majority of cases comprised subjects who fell from heights of 10-20 feet (3-6m) with most falls occurring late at night or in the early morning. The pattern that emerged is quite distinct from ground level falls and pedestrian injuries. Abrasions are the commonest injury and bruises very rare. Lacerations are mostly on the head and skull fractures are evenly distributed between the vertex, base and vertex plus base. Subarachnoid haemorrhage is the commonest intracranial lesion. Extradural haemorrhage alone is rare. Fractures of ribs and cervical vertebrae are common and fractures of thoracic vertebrae and long bones are uncommon. Safety measures to prevent such falls have been suggested.

Fractures of lower cervical vertebrae in the presence of a congenital cleft of the atlas

Fractures of lower cervical vertebrae in the presence of a congenital cleft of the atlas

Frequency of Laryngeal and Hyoid Bone Trauma in Nonhomicidal Cases Who Died After a Fall From a Height

A retrospective study was carried out on 93 autopsy cases who died after a fall from a height. For each case, following parameters were reported: age, sex, manner of death, estimated height of fall, ground type, estimated site of primary impact, type of laryngeal and hyoid bone trauma, presence of associated local trauma in the neck and cephalic region. Mean age of the studied population was about 33 years. Sex ratio (men/women) was 1.8. Mean height of fall was about 15 m. Manner of death was, respectively, suicide and accident in 70 and 23 cases. The type of ground was concrete in 94% of the cases. The site of primary impact was, respectively, head, front of the body, back of the body, feet/lower limbs, and lateral body in 31, 26, 19, 12, and 5 cases. Cervical soft tissue bruising without laryngohyoid fractures was found in 5 cases. Laryngohyoid fractures were found in 5 cases. These fractures could be explained by direct impact of the neck structures against the ground. The mechanism of these fractures could also be indirect fractures due to high muscle strains on the hyoid bone or thyroid cartilage due to cervical hyperflexion or hyperextension or secondary to mandible or cervical vertebral column fractures.

Lateral mass screw fixation for cervical spine trauma: associated complications and efficacy in maintaining alignment

Background context Many studies have documented the efficacy of lateral mass screws, but there are no studies examining the alignment maintenance capability and few large studies examining the complications associated with the use of these devices in cervical spine trauma. Purpose To evaluate complications and alignment maintenance capability associated with lateral mass screw placement for cervical spine trauma by one surgeon at one institution. Study design A retrospective chart and radiograph review of adult patients who underwent lateral mass screw fixation after traumatic injuries to the cervical spine. Patient sample Of 34 consecutive patients with cervical spine injuries who were treated surgically at a level-I regional trauma center, 29 met the inclusion criteria and formed the study group. Outcome measures Sagittal alignment, screw placement, and fusion were assessed on postoperative radiographs. Methods Inclusion criteria included an unstable cervical vertebral fracture or a fracture-dislocation treated with posterior spine fusion and lateral mass instrumentation and a minimum follow-up of 24 months. A review of hospital charts, operative reports, clinic notes, and plain radiographs for the 29 patients was performed, with an emphasis on operative and postoperative complications and alignment maintenance. Results For 28 of the 29 patients, the mean change in sagittal alignment from the immediate postoperative to the most recent follow-up radiographic examination was 2° (range, 0° to 6°). Radiographically, there was one case of instrumentation/fixation failure and loss of sagittal alignment 3 months postoperatively. Other complications included one case of C5 nerve root injury and four wound infections. Conclusions The use of lateral mass screws for traumatic injuries of the cervical spine is associated with excellent maintenance of alignment and minimal complications.

Delayed Esophageal Perforation: A Complication of Anterior Cervical Spine Fixation

Delayed Esophageal Perforation: A Complication of Anterior Cervical Spine Fixation

Abordaje anterior de las fracturas cervicales bajas por mecanismo de hiperflexión o en gota de lágrima

Hyperflexion or teardrop fracture of low cervical vertebrae is characterised by ligament affectation of the entire intervertebral segment, the vertebral body, primarily its anteroinferior third and, frequently, spinal medullar affectation. This series presents the clinical symptoms, diagnosis, surgical approach, and post surgical evolution in 30 patients with tear drop fractures. Over the last 30 years, thirty patients with tear drop fractures at the low cervical spine (C3-C7) were admitted to our Neurosurgical Service. Diagnostic studies included simple radiographs, computerised axial tomography (CT), and magnetic resonance imaging (MRI), all of which evidenced the instability of the damaged segment due to osteoligamentous affectation, and a primarily vertebral body fracture. Patients' neurological status was according to the Frankel' scale adapted to the American Spinal Injury Association scale (ASIA). 11 patients were included in grade A, 5 in B, 3 in grade C, 2 in grade D and 9 grade E of neurological affectation. Surgery through an anterior approach was performed, an average of 5 days after placement of halo traction, which had been placed on admission to the hospital. Surgery consisted in vertebral corporectomy and placement of a plate and a graft from the iliac crest. The patients' neurological evolution was favourable in all cases with incomplete medullar lesions. There were 11 patients with complete lesions, or Frankel grade A affectation; two died due to other associated lesions and the other nine showed no neurological improvement after surgery. The degree of arthrodesis was good and only one patient required an a combined anterior-posterior approach. We conclude that teardrop fractures were associated with severe neurological affectation in more than 50% of our patients, and that these fractures provoke instability requiring arthrodesis, generally via an anterior approach.

Pathological cervical vertebrae fracture of a horse due to lymphosarcoma

Pathological cervical vertebrae fracture of a horse due to lymphosarcoma

Neck injuries among the elderly in Sweden

Neck injuries are some of the most important injuries as they have the potential to influence the spinal cord. A previous national survey of neck injuries in Sweden revealed that injury incidence was increasing for the population over 65 years of age, although it was decreasing for the population as a whole. The aim of this study was therefore to further clarify the magnitude, severity, and external causes of neck injuries in the elderly people in Sweden. A national incidence study, with focus on the age group above 65 years, was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries from 1997 to 1999. Data in the hospital discharge register were reported in ICD9 from 1987 to 1996, while data from 1997 to 1999 were reported in ICD10. During the study period 4168 cervical injuries occurred of which 341 were fatal. People above 65 years of age made up 17% of the population and sustained 30% of all cervical injuries and 43% of all fatal cervical injuries. Half of the cervical injuries were axis (C2) fractures. Lower vertebral fractures occurred in 16% of the cases and atlas (C1) fractures in 11%. The cervical soft tissue injuries amount to 19% of all injuries. Fall accidents account for the majority (71%) of the accidents. There is an increasing trend for fall accidents resulting in neck injuries. The male population has a higher incidence for neck fractures than females, disregarding the external cause of injury. The upper cervical injuries are the most common, have the longest hospital treatments, and seem to be caused mainly by low energy falls. Further research is needed to understand the mechanisms of these injuries and in this aspect engineering could contribute with valuable knowledge, through accident simulations with numerical models. The increasing incidence of fall injuries calls for further preventive actions. The public sector should implement preventive strategies to reduce the number of extrinsic accidents, while the health care sector should focus on preventing intrinsic accidents with individual actions for each patient.

Cervical injuries in Sweden, a national survey of patient data from 1987 to 1999

Neck injuries are one of the most important injuries as they have the potential to influence the spinal cord. Data from most parts of the world are not sufficient to define a comprehensive view of mortality, morbidity, disability and handicap due to neck injuries. In Sweden, there are no data on the incidence of neck injuries. The aim of this study is to define the national incidence and causes of neck injuries in Sweden. An incidence study was undertaken with data from the injury surveillance program at the Swedish National Board of Health and Welfare. The investigation includes cervical vertebral fractures reported between 1987 and 1999, and cervical soft tissue injuries over a period of three years, from 1997 to 1999. Data between 1987 and 1996 were reported in ICD 9, while data from 1997 to 1999 were reported in ICD 10. During the study period, 14,310 non-fatal and 782 fatal cervical injuries occurred. A decreasing incidence for cervical fractures can be seen for the Swedish population, except for the elderly that have a slight increase in incidence. The incidence for cervical soft tissue injuries is almost constant. Cervical fractures demand longer periods of hospitalization than the soft tissue injuries. Transportation-related cervical fractures have dropped since 1991, while soft tissue injuries increased slowly between 1997 and 1999. Fall accidents are now the largest external cause of cervical fractures, and the population above 65 years accounts for almost 50% of the fall accidents. The male population has a higher incidence of cervical fractures, disregarding age. It is concluded that safety programs for transportation-related injuries in Sweden have been successful, while fall accidents are still substantial. Much more can be done to prevent neck injuries; especially to reduce the number of transportation-related cervical soft tissue injuries and fall injuries in the elderly population.

Ventral fixation of cervical vertebral fractures in two red kangaroos using screws and polymethylmethacrylate

SummaryFractures of the cervical vertebrae in two tetraparetic juvenile red kangaroos were stabilized using a modified ventral screws and polymethylmethacrylate technique. One kangaroo developed terminal ventilatory complications during anaesthesia. The second recovered normal mobility.

Cervical vertebral fracture in three foals

Cervical vertebral fracture in three foals

The devastating potential of blunt vertebral arterial injuries.

To formulate management guidelines for blunt vertebral arterial injury (BVI). Compared with carotid arterial injuries, BVIs have been considered innocuous. Although screening for BVI has been advocated, particularly in patients with cervical spine injuries, the appropriate therapy of lesions is controversial. In 1996 an aggressive arteriographic screening protocol for blunt cerebrovascular injuries was initiated. A prospective database of all screened patients has been maintained. Analysis of injury mechanisms and patterns, BVI grades, treatment, and outcomes was performed. Thirty-eight patients (0.53% of blunt trauma admissions) were diagnosed with 47 BVIs during a 3.5-year period. Motor vehicle crash was the most common mechanism, and associated injuries were common. Cervical spine injuries were present in 71% of patients, but there was no predilection for cervical vertebral level or fracture pattern. The incidence of posterior circulation stroke was 24%, and the BVI-attributable death rate was 8%. Stroke incidence and neurologic outcome were independent of BVI injury grade. In patients treated with systemic heparin, fewer overall had a poor neurologic outcome, and fewer had a poor outcome after stroke. Trends associated with heparin therapy included fewer injuries progressing to a higher injury grade, fewer patients in whom stroke developed, and fewer patients deteriorating neurologically from diagnosis to discharge. Blunt vertebral arterial injuries are more common than previously reported. Screening patients based on injury mechanisms and patterns will diagnose asymptomatic injuries, allowing the institution of therapy before stroke. Systemic anticoagulation appears to be effective therapy: it is associated with improved neurologic outcome in patients with and without stroke, and it appears to prevent progression to a higher injury grade, stroke, and deterioration in neurologic status.

Dysphagia due to Diffuse Brain Injury with Cervical Vertebrae Fracture and Thoracic Spinal Cord Injury

Dysphagia due to Diffuse Brain Injury with Cervical Vertebrae Fracture and Thoracic Spinal Cord Injury

Cervical vertebral fractures in 56 dogs: a retrospective study.

The clinicopathological features of cervical fractures in 56 dogs were reviewed. "Hit by car" (HBC) was the most common inciting cause, and the axis and atlas were the vertebrae most frequently affected. Surgical treatment was associated with high (36%) perioperative mortality. However, all dogs that survived the perioperative period achieved functional recovery. Functional recovery was achieved in 25 (89%) of 28 nonsurgically treated dogs with adequate follow-up. Overall, severity of neurological deficits (nonambulatory status) and prolonged interval (five days or longer) from trauma to referral were associated with poorer outcome. Nonsurgical treatment is a viable therapeutic approach for many dogs with cervical fractures. Early neck immobilization and prompt referral are recommended, because delay in referral decreases the likelihood of functional recovery.

Treatment of stable burst fracture of the atlas (Jefferson fracture) with rigid cervical collar.

A retrospective review of a clinical series. To evaluate the use of a rigid cervical collar alone as the treatment for stable Jefferson fracture, and to devise an algorithm for treatment of Jefferson fracture with or without an associated cervical injury. The traditional treatment for Jefferson fracture, if there is no indication for surgery, is immobilization by halo vest. Because halo vest placement is associated with intracranial infection and a significant degree of patient discomfort, slightly less rigid forms of external immobilization may be useful for the treatment of stable Jefferson fractures. No standard protocol calling for the use of one form of stabilization device has been reported. The medical records and radiographs of 16 consecutive patients with Jefferson fracture during a 2-year period were reviewed. Each patient underwent a complete cervical radiograph series and a computed tomographic scan. The mean C1 lateral mass displacement was 1.8 mm. Cervical spine radiographs, including lateral flexion-extension views were obtained 10 to 12 weeks after injury before the removal of an external immobilization device. Of these 16 patients, 1 sustained a complete injury, and 7 sustained an incomplete injury. Eight patients were neurologically intact. Twelve patients sustained a stable Jefferson fracture and were treated with a rigid cervical collar (Miami-J collar [Jerome Medical, Moorestown, NJ]) alone from 10 to 12 weeks. The patient sustaining the complete neurologic injury died of multisystem trauma. All 15 live patients showed no instability on their follow-up plain radiographs before the removal of an external stabilization device. Six patients underwent further plain radiographs approximately 1 year after the fracture and similarly demonstrated no instability. Isolated stable burst fracture of the atlas can be treated effectively with a rigid cervical collar alone for 10 to 12 weeks with good neurologic recovery and segmental stability. Unstable Jefferson fractures with concurrent unstable fracture of other cervical vertebrae, especially C2, requires surgical stabilization.

Pediatric Cervical Spine Injury Sustained in Falls From Low Heights

Study objective: To determine whether history and clinical examination findings can identify young children who have sustained cervical injury after falling short distances. Methods: We conducted a retrospective review of the medical records of children younger than 6 years old with the diagnosis of cervical vertebral fracture or cervical spinal cord injury after a fall of less than 5 feet. Data from medical records over an average time span of 11 years at four large children's hospitals were compiled. Results: We identified eight children who sustained cervical spine injury after a fall of less than 5 feet. These children ranged in age from 9 to 68 months. Three had rotary subluxation of C1, and three had subluxation of C1–C2. One of the children in the latter group also had an odontoid fracture. Two children had a fracture of C2. All the children had limited range of motion of the neck or neck pain. Conclusion: All children in this study with the diagnosis of cervical spine injury had clinical evidence of that injury on history or physical examination. Clinicians treating asymptomatic young children who sustain short falls may not need to perform radiographic evaluation of the cervical spine. [Schwartz GR, Wright SW, Fein JA, Sugarman J, Pasternack J, Salhanick S: Pediatric cervical spine injury sustained in falls from low heights. Ann Emerg Med September 1997;30:249-252.]