Incidence Of Cervical Spine Injuries Research Articles

Cervical spine injury complicating facial trauma: Incidence and management

Purpose: To review the impact of concomitant cervical spine injury on the management of facial fractures in a tertiary care institution via a retrospective chart review. Patients and Methods: Within the past 10 years, 1,750 consecutive patients presented to our institution with facial fractures. Thirty-two had concomitant cervical spine injury. Five were transferred or died before treatment. The remaining 27 charts were reviewed in detail. Results: The incidence of cervical spine injury among patients with facial fractures in our study was 1.8%. There were no treatment delays attributed to these injuries. Of note was the inaccuracy of lateral cervical spine films in 9 of 27 cases (33%). Conclusion: Although uncommon, cervical spine injury must be thoroughly ruled out before evaluation and management of facial trauma. Concomitant cervical spine injury should not delay appropriate and timely treatment of facial fractures because adequate means of intraoperative stabilization are readily available.

Incidence and type of cervical spine injuries associated with mandibular fractures

The incidence of facial fractures accompanied by spinal injuries, while low, is of significant concern to the craniomaxillofacial surgeon. There are conflicting reports on the association between facial fractures and concomitant spinal damage. This retrospective study of 424 patients with mandibular fractures examines the relationship of mandibular fractures and concomitant spinal injuries. The incidence of concurrent mandibular and cervical fractures was 2.6%, predominantly associated with motor vehicle accidents. The purpose of this study is to examine the incidence of cervical spine injury associated with mandibular fractures, in order to improve the diagnosis and treatment of spinal injury associated with mandibular fractures.

A Retrospective Study of Cervical Spine Injuries in American Rugby, 1970 to 1994

We undertook a retrospective study to document and analyze the occurrence of cervical spinal injuries in rugby in the United States from 1970 to 1994. We studied 59 cases (average, 2.36 per year). Thirty junior-level players (50.8%) (college or high school), 28 (47.5%) men's club players, and 1 (1.7%) woman player were injured. Fifty-seven injuries (97%) occurred during games. The incidence of cervical spine injuries is well documented in the United Kingdom and South African literature. However, no study in United States literature discusses the incidence or cause of cervical spine injury in rugby. We found that coaching is less consistent in the United States. Players with more weight and less experience are playing positions that require significant skill. Many players in the United States learn skills in games rather than in practice. In our study, 52.5% (31 of 59) of the injured players were junior-level players. Conversely, in world competition junior-level athletes sustained only 30% to 40% of the cervical spine injuries. Understanding the factors that contribute to cervical spine injuries is paramount in injury prevention. Through this study, we hope to promote change in rugby laws and regulations, as has been done in football, to enhance the safety and pleasure of the sport for players, coaches, and spectators.

Incidence of Cervical Spine Injury in Patients With Gunshot Wounds to the Head

Cervical spine immobilization is standard during the early stages of prehospital and hospital care of patients with blunt head injury. However, the need for cervical spine immobilization in patients with gunshot wounds to the head has not been addressed. To determine the incidence and types of cervical spine injury in this group, we retrospectively examined the records of 308 consecutive patients who had computed tomographic (CT) scans of the head to evaluate brain injury after gunshot wounds. Of the 266 patients with data adequate for review, 157 (59%) had a complete lateral x-ray film of the cervical spine. Of these 157, 105 had wounds limited to the calvaria, and none had cervical spine injury. Of 52 patients with complete lateral x-ray films and wounds not limited to the calvaria, 5 (10%) had cervical spine or spinal cord injury. Of the 192 patients who had CT-proven intracranial injury, 86 (45%) required immediate intubation before x-ray films were obtained, and 67 (35%) died. We conclude that cervical spine immobilization may not be required during endotracheal intubation of brain-injured gunshot victims with wounds limited to the calvaria.

Roentgenographic evaluation of the cervical spine. A selective approach.

To determine if routine radiographic evaluation of the cervical spine could be eliminated in the alert, sober trauma patient who has no neck pain, tenderness, or other major injuries without a significant increase in missed occult injury. Prospective cohort study. Emergency department and general surgery service at a military tertiary medical center. Those patients with cervical spine injuries. Sixteen patients (2%) had cervical spine injuries, all had signs and/or symptoms of their injury on presentation. Ninety-six patients (14%) who were not intoxicated and had no neck pain, tenderness, or other major injuries were evaluated. None of these patients had abnormal cervical spine studies. Two hundred ninety patients (43%) were followed up between 30 to 150 days. No missed injuries were noted. These results indicate that blunt trauma patients may not require cervical spine roentgenography if they meet the following criteria: absence of mental status changes, intoxication, neck pain or tenderness, neurologic signs or symptoms, or simultaneous major distracting injury. Because of the small incidence of cervical spine injuries, further studies are necessary to evaluate the positive predictive value of history and physical examination of the cervical spine in a trauma patient.

Epidemiology, biomechanics, and prevention of cervical spine trauma resulting from athletics and recreational activities

Cervical spine injury resulting from athletic and recreational activities with concomitant involvement of the spinal cord are infrequent but catastrophic events. Data from the National Football Head and Neck Injury Registry over the past 20 years clearly indicate the preventability of these injuries. Simply put, there is no such thing as a "freak" injury: for every effect there is a cause. Identification of the axial load mechanism, as translated into the football rule changes of 1976, has resulted in a dramatic decrease in both the total number of cervical spine injuries and those resulting in quadriplegia at both the high school and college levels. The potential danger and incidence of cervical spine injuries resulting from water sports are, for the most part, not generally appreciated. In view of the potential for disaster associated with unsupervised water activities, education of the public regarding appropriate safety guidelines is essential.

IS HELMET USE BENEFICIAL TO MOTORCYCLISTS?

This study included 83 motorcyclists, helmeted and nonhelmeted, involved in crashes. All these patients were flown to a major trauma center in the Northeast (Hartford Hospital, Connecticut) directly from the scene by a helicopter ambulance service (LifeStar). The study showed that the majority of these patients were male and under the age of 30 years. Twenty-seven had blood alcohol levels above the legal limit. Sixty-nine percent were nonhelmeted and, statistically, a significant number in this category had a Glasgow Coma Scale (GCS) score of 8 or under. Cervical spine injuries were discovered in only six patients. Nine of the ten patients declared dead on arrival (DOA) were nonhelmeted. We conclude that helmets provide protection and certainly do not increase the incidence of cervical spine injuries.

Cervical spine injuries in blunt trauma patients requiring emergent endotracheal intubation

Airway management in the blunt trauma patient is complicated by the potential for causing or exacerbating an injury to the cervical cord if an unstable cervical fracture is present. The records of 987 blunt trauma patients who required emergent endotracheal intubation over a 5-year period were retrospectively reviewed to determine the incidence and type of cervical spine injury and the incidence of injury based on airway management. Sixty of the patients (6.1%) had a cervical fracture; 53 were potentially unstable injuries by radiographic criteria. Twenty patients had neurologic deficits prior to intubation. Twenty-six patients with unstable injuries were intubated orally, 25 nasally, and two by cricothyrotomy. One patient developed a neurologic deficit after nasotracheal intubation. Because of a possible selection bias in which severely injured patients were preferentially referred to this trauma center, the true incidence of cervical spine injuries may be lower than the 6.1% we found. The authors conclude that the incidence of serious cervical spine injury in a very severely injured population of blunt trauma patients is relatively low, and that commonly used methods of precautionary airway management rarely lead to neurologic deterioration.

Incidence of cervical spine injuries in association with blunt head trauma

To establish an incidence of cervical spine injuries in significant blunt head trauma and to evaluate the necessity of using cervical radiography, all consecutive cases of blunt head trauma admitted to the trauma service over a 7-month period were reviewed. Two hundred twenty-eight charts were reviewed for demographic information, circumstance of injury, complaints and physical findings referable to the cervical spine, presenting level of consciousness, severity of head injury, and cervical spine radiographic findings. Only three patients were found to have cervical spine injuries, for an incidence of 1.7%. Of the 122 alert and asymptomatic patients, none had cervical spine injury. The patient population was defined, yet the very low incidence of cervical spine injuries associated with blunt head trauma in this study precludes any identification of predictors. Nevertheless, the results suggest that alert and asymptomatic patients can be spared cervical spine radiography.

The National Football Head and Neck Injury Registry

Data on cervical spine injuries resulting from participation in football have been compiled by a national registry. Analysis of epidemiologic data and cinematographic documentation clearly demonstrated that the majority of cervical fractures and dislocations were due to axial loading. On the basis of this observation, rule changes banning both deliberate "spearing" and the use of the top of the helmet as the initial point of contact in making a tackle were implemented at the high school and college level. Subsequently, a marked decrease in cervical spine injury rates has occurred. The occurrence of permanent cervical quadriplegia decreased from 34 in 1976 to five in the 1984 season. It is suggested that axial loading of the cervical spine is also responsible for the catastrophic injuries in diving, rugby, ice hockey, and gymnastics. Implementation of appropriate changes in playing techniques and/or equipment modifications could possibly reduce the incidence of cervical spine injuries in these activities.

The National Football Head and Neck Injury Registry. 14-year report on cervical quadriplegia, 1971 through 1984

Data on cervical spine injuries resulting from participation in football have been compiled by a national registry. Analysis of epidemiologic data and cinematographic documentation clearly demonstrated that the majority of cervical fractures and dislocations were due to axial loading. On the basis of this observation, rule changes banning both deliberate "spearing" and the use of the top of the helmet as the initial point of contact in making a tackle were implemented at the high school and college level. Subsequently, a marked decrease in cervical spine injury rates has occurred. The occurrence of permanent cervical quadriplegia decreased from 34 in 1976 to five in the 1984 season. It is suggested that axial loading of the cervical spine is also responsible for the catastrophic injuries in diving, rugby, ice hockey, and gymnastics. Implementation of appropriate changes in playing techniques and/or equipment modifications could possibly reduce the incidence of cervical spine injuries in these activities. (<i>JAMA</i>1985;254:3439-3443)

Prospective study of injuries in United States Ski Association freestyle skiing--1976-77 to 1979-80.

This report documents a prospective study of injuries in USSA (United States Ski Association) Freestyle competition undertaken during the four seasons from 1976-77 through 1979-80. In order to ensure adequate reporting and documentation, the study was confined to actual observed competition days. Competition and accident reports were prepared by a representative of the USSA-sanctioned organization conducting each of the competitions studied. Report forms were designed with reference to prior ski accident studies and included demographic information in addition to specific information related to the nature of freestyle ski competition. History and background relative to the disciplines of freestyle skiing is given, including the three disciplines of ballet, aerials, and moguls. Data on 10,118 skier-days revealed incidence of injury to be 2.8 per 1,000 skier-days. The distribution of injury to location and type was not similar to that encountered in recreational skiers, and a relatively higher incidence of spine, head, and upper extremity injuries was noted. No incidence of cervical spine injury was encountered. All injured competitors were able to return to competition following recovery from their injuries. This study directs attention to specific aspects of freestyle competition which will require changes in order to further reduce the incidence of injury.

Occult cervical spine injuries in fatal traffic accidents.

Post-mortem radiographs as well as careful inspection at autopsy of 100 consecutive traffic accident victims revealed an incidence of cervical spine injury of 24%. All but four of the 24 fractures and/or dislocations were localized to the level between the occiput and the axis. One half of the cases were not clinically suspected of having spine injuries before the detailed postmortem search. Seventeen of the 24 cervical spines were resected en bloc and the pathologic anatomy of the injuries was determined. The high incidence of cervical spine injuries and the anatomic findings at dissection have clinical implications for physicians who manage multiply traumatized patients. The need for immobilization and early radiographic evaluation of patients with cervical spine injuries is emphasized.