Evaluation Of Cervical Spine Trauma Research Articles

Chapter 32 - Cervical spine trauma evaluation

Cervical spine trauma is a relatively rare but catastrophic event in sports. These critical situations depend on sports medicine personnel understanding every aspect of sideline care to ensure a safe and successful evaluation. This involves thorough preparation, vigilant observation of the sporting event to detect the possible mechanism of injury, and initiation of the appropriate action plan when a potentially catastrophic injury is suspected. Sideline management of cervical spine trauma requires the appropriate primary survey, with spine stabilization if necessary, secondary survey for concomitant injury, and, potentially, initiation of full spine stabilization with a spine board. In this chapter, our primary focus is discussion of the sideline evaluation of cervical spine trauma, and sideline practices designed to stabilize the athlete and minimize risk for further injury.

CONVENTIONAL X-RAY AND COMPUTED TOMOGRAPHY FINDINGS OF CERVICAL SPINE TRAUMA

Background: Cervical spine trauma is a serious and complicated injury, affects both spine and spine cord. Evaluation of cervical spine trauma is crucial for selecting effective treatment methods. Purposes: To describe characteristics on X-ray and CT scanner of the cervical spine in trauma and to evaluate the value of X-ray for the cervical spine trauma. Materials and Method: A cross-sectional study of 33 patients with cervical spine injury seen on CT from 08/2014 to 08/2015 at Hue Central Hospital and Hue University Hospital. Results: Average age was 43 years. The majority was males (the ratio was 4.5). The most common reason of injury were motor vehicle crashes and labor accidents. The most common site of injury was C5 - C6 level. There were 4/33 cases of upper cervical spine fractures and there were 29/33 cases of lower cervical spine fractures, in which blunt fracture, dislocation fracture, simple fracture were mainly identified on CT than on X-ray, p <0.05. The Kappa value for measuring the realiability between X-ray and CT in findings of body spine fractures was moderate (0.41 < K = 0.598 < 0.6). The ratio in finding posterior arch of lower cervical spine fractures on CT were higher than on X-ray, particularly in laminar frature and multiple sites fracture. There was no diagnostic suitability between X-ray and CT in detecting posterior arch of lower cervical spine fractures, K= 0.115 < 0.2. Conclusion: X-ray is still valuable in clinical practice in medical facilities that have not been equipped with modern specialized equipment in odontoid fracture type 2, Hangman fracture and dislocated injuries besides using CT and MRI. Key words: Cervical vertebrate; Trauma; Morphologic characteristics

Characteristics of Cervical Spine Trauma in Patients with Ankylosing Spondylitis and Ossification of the Posterior Longitudinal Ligament

To compare the clinical characteristics of cervical spine trauma in patients with ankylosing spondylitis (AS) and cervical ossification of the posterior longitudinal ligament (OPLL) with those of a control group. A total of 124 patients with cervical spine trauma from January 2004 to December 2013 were reviewed. Fourteen patients were diagnosed with AS and 25 patients were diagnosed with OPLL; 85 patients were controls. C-spine plain radiography, computed tomography, and magnetic resonance imaging were obtained for evaluation of cervical spine trauma. The American Spinal Injury Association impairment scale and Subaxial Cervical Spine Injury Classification were used to evaluate the neurologic status of patients and the fracture mechanism. Patients with AS or OPLL had more spinal injuries associated with minor trauma than did the control group. All patients with AS had spinal fracture injuries after cervical spine trauma, but patients with OPLL mostly had spinal cord injuries without bony fractures. After cervical spine trauma, delayed diagnosis occurred in 3 patients with AS (21.4%) and 4 patients with OPLL (15.6%). Improvement from neurologic deficit after treatment showed better outcomes in patients with AS and OPLL than in controls (P= 0.106). Patients with AS or OPLL who had cervical spine trauma showed different characteristics and outcomes than control patients. Proper surgical treatment led to better outcomes in both patients with AS and patients with OPLL than in control patients. Moreover, it is important to thoroughly examine patients with AS or OPLL after cervical trauma so as not to delay diagnosis.

Clinical, Radiographic and Magnetic Resonance Imaging Evaluation of Cervical Spine Trauma

Clinical, Radiographic and Magnetic Resonance Imaging Evaluation of Cervical Spine Trauma

MDCT and MRI evaluation of cervical spine trauma

PurposeCervical spine injuries following major trauma result in significant associated morbidity and mortality. Devastating neurological injury, including complete and incomplete tetraplegia, are common sequelae of cervical spine trauma and cause profound and life-altering medical, financial, and social consequences. Most cervical spine injuries follow motor vehicle accidents, falls, and violence. The proliferation of multidetector computed tomography allows for fast and accurate screening for potential bony and vascular injuries. Magnetic resonance imaging is useful for evaluation of the supporting ligaments and the spinal cord after the patient has been stabilised.ConclusionCervical spine injuries are approached with much caution by emergency room clinicians. Thus, it is essential that radiologists be able to differentiate between a stable and unstable injury on MDCT, as this information ultimately helps determine the management of such injuries.Teaching Points: MDCT and MRI are complementary and both may be needed to define injuries and determine management. MDCT rapidly evaluates the bones, and MRI is superior for detecting ligament and cord injuries. Injury to one of the three spinal columns may be stable, and injuries to more than one are unstable. Instability may cause abnormal interspinous and interpedicular distances, or cervical malalignment. Fractures of the foramen transversarium are associated with vertebral arterial dissection.

Use of stand-up magnetic resonance imaging for evaluation of a cervicothoracic injury in a patient with ankylosing spondylitis

Background context Injuries at the cervicothoracic junction are common in patients with ankylosing spondylitis. These injuries present challenges for both initial and follow-up imagings. Purpose To describe a case of a patient with ankylosing spondylitis who was treated with laminectomy and a cervicothoracic orthosis for a spinal epidural hematoma after a nondisplaced fracture at the cervicothoracic junction and to discuss the merits of stand-up magnetic resonance imaging (MRI) for follow-up evaluation of this type of injury. Study design/setting Case report. Methods Clinical data of a patient with ankylosing spondylitis who sustained a nondisplaced C7 fracture are presented, followed by a detailed review of the literature concerning imaging techniques available for the evaluation of cervical spine trauma in this patient population. Results The patient was treated with emergent laminectomy and evacuation of the epidural hematoma, followed by definitive management in a cervicothoracic orthosis secondary to medical comorbidities. The patient was then successfully followed postoperatively with stand-up MRI because conventional imaging techniques could not adequately image the injury level in an upright position. Conclusions Cervicothoracic injuries are common in patients with ankylosing spondylitis and may be difficult to follow with conventional imaging techniques. Stand-up MRI is a relatively new modality that may offer significant advantages over conventional imaging because of the ability to evaluate the cervicothoracic junction in a more functional position and the lack of a confining space such as that found in standard MRI units.

Cervical spine trauma in children under 5 years: productivity of CT.

The aim of the study was to determine the value of CT in the evaluation of cervical spine trauma in children under 5 years in the Emergency Department. A retrospective review of 606 patients undergoing cervical spine examination in the emergency room was undertaken. The age and sex of the patients were documented, and in addition presence or absence of fracture-dislocation was noted on each of the plain film and CT studies. Of the 606 patients studied, 459 (75.7%) were cleared by a combination of clinical and plain film radiographic findings. The other 147 (24.3%) went on to CT imaging for clearing of the cervical spine. Of the 147 patients evaluated with CT, 143 (97.3%) had exams that were negative for fracture, dislocation, and instability. Only four (2.7%) demonstrated positive findings for fracture, dislocation, or instability. All of these patients had positive, diagnostic findings on initial plain film evaluation. Another five patients demonstrated new findings which were unrelated to trauma and of no clinical consequence. The yield of positive, clinically significant findings on CT of cervical spine injuries in children less than 5 years was low and showed significant findings only in patients where the same findings were seen on initial plain radiographs.

The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects.

The purpose of this study was to determine the value of flexion and extension MR in traumatized cervical spines following rear low-impact acceleration-deceleration injury. The cervical spines of 100 consecutive uninjured normal asymptomatic adults and 100 adult accident victims following rear low-impact motor vehicle accidents were evaluated using rapid T2-weighted MRI. Subjects were matched for age but not gender. The age range was 18 to 53 years, with a mean of 35 years. Injured subjects were evaluated during the subacute period, at 12 to 14 weeks after injury, following clinically resolved muscle spasm. Imaging findings were compared between normal and injured subjects. The normal subjects showed a stepwise segmental motion pattern that started at C1-C2 and transmitted to the lower cervical segments. Loss of normal cervical lordosis (hypolordosis) was observed in 4% (4 of 100) patients. Normal range of motion (rounded to the nearest 5 masculine ) was quantified as 50 masculine flexion (range, 45-65 masculine; standard deviation, 6.5 masculine ) and 60 masculine extension (range, 50-70 masculine; standard deviation, 6.5 masculine ). Asymptomatic disk herniations were observed in 2% (2 of 100) patients. In the subacute post-traumatic subjects, there was a loss of the normal segmental motion pattern, with hypolordosis in 98% (98 of 100) patients. Range of motion (rounded to the nearest 5 masculine ) was restricted, quantified as 25 masculine flexion (range, 5-40 masculine; standard deviation, 15 masculine ) and 35 masculine extension (range, 20-50 masculine; standard deviation, 10 masculine ). Disk herniations were observed in 28% (28 of 100) patients. Biomechanical changes in the herniated disk were noted, with mildly increased spinal stenosis following flexion. The authors conclude that flexion and extension MR can be a valuable adjunct examination in the evaluation of patients in the clinical setting of subacute cervical spine trauma.

Radiographic evaluation of cervical spine trauma: Procedures to avoid catastrophe : Montgomery JL, Montgomery ML. Postgrad Med 95:173–196, 1994

Radiographic evaluation of cervical spine trauma: Procedures to avoid catastrophe : Montgomery JL, Montgomery ML. Postgrad Med 95:173–196, 1994

Efficacy of limited CT for nonvisualized lower cervical spine in patients with blunt trauma

Records of 100 patients with blunt injury and nonvisualization of C7 and T1 on cross-table lateral and swimmer's views were reviewed to evaluate the usefulness of limited computed tomographic (CT) scans in "clearing" the lower cervical vertebrae of injury. CT was deemed necessary and performed in all of these cases because the lower cervical spine could not be evaluated clinically or with plain radiographs. Ninety-seven of these 100 patients had normal findings on CT and only three patients showed cervical spine fractures. All three had isolated and stable fractures. Two of these patients had "clay-shoveler" fractures at C6 and C7, respectively, and one had a single laminar fracture at C7. All three patients were conservatively treated. This study emphasizes the value of clinical correlation in the evaluation of cervical spine trauma. When deemed necessary in symptomatic patients, CT is useful to exclude skeletal injury in the lower cervical spine thus avoiding delay in the patient's workup and unnecessary hospitalization, and expediting patient discharge. Lack of pain and neurological findings in nonintoxicated, conscious, and alert patients is generally not associated with significant soft tissue or skeletal injury.

Radiographic evaluation of cervical spine trauma.

Preview A patient with a suspected cervical spine injury must be handled with the utmost care until fractures and other causes of instability have been excluded. In this article, the authors describe essential imaging techniques and discuss the evaluation of common- and some uncommon- injuries.

The next logical step in the emergency radiographic evaluation of cervical spine trauma: The five-view trauma series

The five-view standard series is considered the golden standard in the radiographic evaluation of the cervical spine. Although tho three-view trauma series has proved significantly more accurate than the cross-table lateral view in the emergency evaluation of patients with cervical spine trauma, this series does not deal with questionable findings. The introduction of a five-view trauma series, with the inclusion of supine oblique views, is the next logical step in the emergency evaluation of these patients. An algorithm for the emergency radiographic evaluation of patients with suspected cervical spine trauma is proposed.

Roentgenographic Evaluation of Cervical Spine Trauma

A practical approach to the roentgenographic assessment of a patient suspected of having a cervical spine injury is described. Once positioned, the patient is not moved until substantial bony injury has been excluded. The major roentgenographic signs with differential diagnosis are briefly discussed using some illustrative roentgenograms.

Roentgenographic evaluation of cervical spine trauma

Roentgenographic evaluation of cervical spine trauma