Treatment Of Cervical Spine Injuries Research Articles

Delayed Surgical Treatment of Cervical Spine Injury in an Adolescent Patient

Introduction. Cervical spine injury is recognised as one of the most disabling types of vertebral column and spinal cord injuries. With a high level of disability, this type of injury remains quite rare among children. The main types of complications in this kind of injury include impaired regulations of the respiratory and cardiovascular systems, tetra- and paraparesis, and pelvic organ disorders. The analysis of recent publications indicated early surgery (in less than 24 hours) as the main condition for reducing post-traumatic complications.Materials and methods. The paper presents a clinical case of delayed surgery (in more than 24 hours) performed in a 17-year-old patient who was admitted to hospital after a traffic accident. After diagnostic measures, according to indications, a delayed surgery was performed on day 3: anterior spine fusion at the level of C5-Th1 with the installation of a vertebral body endoprosthesis and fixation with a bone plate.Results and discussion. The present case confirms the need for patients with combined spinal cord injury and mild traumatic brain injury to undergo a full range of diagnostic examinations including: brain and spine imaging, and, in the presence of compression and signs of spinal cord injury, MRI of the spinal cord (if necessary, the brain) at the level of injury. In the absence of gross structural damage to the brain, urgent decompression of the spinal cord and spine stabilization are indicated to eliminate the traumatic and spinal shock.Conclusion. Mild traumatic brain injury cannot be considered a contraindication for delayed cervical spine surgery. The present case is indicative of early surgical treatment of spinal injury, especially of the cervical spine, without neurological onset. All diagnostic measures were performed in full. Despite the surgical treatment and rehabilitation measures, the neurological deficit in the patient was not completely eliminated and persisted after 1 year.

Tactics of treatment of severe spinal injuries using modern technologies

The experience in treatment of 139 patients with cervical (71 patients) and thoracolumbar (68 patients) spine injuries is reviewed. The treatment of cervical spine injuries was performed with halo apparatus which was more effective in injuries of upper cervical zone. In 14 patients with lower cervical spine injuries the surgery with Orion system was carried out. All patients with fractures or posttraumatic deformities of the thoracic and lumbar spine underwent operative treatment. Eight patients had systemic osteoporosis. Reduction-stabilization operations with decompression and different spondylodesis were also performed. Steffee system was used in 33 cases, Cotrel-Dubousset in 22, Tenor in 7, and Luque in 6 cases. Operative stabilization allowed to achieve primary rigid fixation of the mobile injured lumbar segments for early activization of patients. For the achievement of good outcome the different choice of curative tactics is required. Concomitant osteoporosis significantly influences the long term results. Long term preservation of stability depends on the proper choice and the length of a fixation device as well as on the method of spondylodesis.

Approach and considerations for surgery in subaxial cervical spine injury: A narrative review

Subaxial cervical spine injuries are common and encompass a spectrum of injuries ranging from a minor ligamentous sprain to fracture dislocation with spinal cord injury. These injuries are often missed in the initial evaluation, and a high index of suspicion is needed to evaluate and diagnose these injuries, which otherwise could lead to spinal cord injury. Computed tomography scans are the gold standard in the evaluation of fractures as plain radiographs have limited sensitivity. Magnetic resonance imaging (MRI) is necessary to identify injury to the disco-ligamentous complex and to assess cord injury. The principles of the treatment of cervical spine injuries include early immobilization to prevent secondary neurological injury, achieving alignment by reduction and stabilization of the unstable injured segment and decompression of the cord in the presence of cord injury. Owing to a broad spectrum of injuries, there is no unified approach, and the management plan depends on the morphology of injury, the extent of structures damaged, and the presence of neurological impairment. Various classifications grade and help assess the severity of the injury. Minor injuries are conservatively managed with cervical orthoses, and unstable injuries require stabilization either anterior, posterior, or combined approaches, depending on the injury morphology. Controversy exists over the safety of closed reduction in facetal subluxations, need for pre-reduction MRI, and the ideal approach for each injury. This review presents the current evidence and guidelines on the management of subaxial cervical spine injuries.

The Management of Cervical Spine Injuries - A Literature Review.

Due to the inherent bony instability of the cervical spine, there is an over-reliance on ligamentous structures for stability, making this segment of the vertebral column most prone to traumatic injuries. The frequently occurring mechanisms of injury include axial compression, hyper-flexion, hyper-extension, and rotational type injuries. Good pre-hospital care and a thorough assessment in the emergency department of patients suspected to have a cervical spine injury (CSI) leads to improved clinical outcomes. The objective of the initial evaluation of a patient with a suspected CSI is to identify the presence of injuries through thorough clinical and radiologic assessments as missed injuries are potentially catastrophic. The treatment of cervical spine injuries can be conservative, pharmacological, or surgical, and aims to halt SCI progression, stabilize the spine, and to allow rehabilitation of the patient.

Neurosurgical treatment of cervical spine injuries

Injuries of the cervical spine are quite common with an incidence of more than 3% in trauma patients. The incidence is even higher in elderly patients. Cervical spine injuries might induce severe neurological deficits. Therefore, they must be quickly and adequately diagnosed and treated. Depending on the pattern of injury, conservative or surgical treatment is indicated. The authors describe the different surgical strategies and treatment options based on the pattern of injury. Typical surgical methods are illustrated by case presentations. Cervical spine injuries should be treated in atrauma centre with extensive expertise in spine surgery. The immobilisation and gentle transportation is important already at the scene of the accident. Nowadays, there are excellent surgical options and strategies available as well as excellent intensive care therapy. These possibilities lead to rapid and good stabilisation of cervical spine injuries and the posttraumatic morbidity and mortality can be reduced significantly especially in elderly patients.

Operative Treatment of Severe Cervical Spine Injuries Sustained in Youth Sports: Experience from a Pediatric Level 1 Trauma Center over a 16-Year Period

Background:Sports-related cervical spine injuries (CSI) are devastating traumas with the potential for permanent disability. There is a paucity of literature on operative CSI sustained in youth athletes.Hypothesis/Purpose:The aims of this study aims were to review injury characteristics, surgical treatment, and outcomes of severe pediatric CSI encountered in youth sports.Methods:We reviewed children less than 18 years old with operative sports-related CSI at a pediatric Level 1 pediatric trauma center between 2004−2019. All cases underwent modern cervical spine instrumentation and fusion. SCI were stratified according to the American Spinal Injury Association Impairment Scale (ASIA). Clinical, radiographic, and surgical characteristics were compared between groups of patients with and without spinal cord injury (SCI).Results:Three thousand two hundred and thirty-one children (mean, 11.3y±4.6y) were evaluated for CSI at our institution during the 16-year period. The majority of traumas resulted from sports/recreational activities and were seen in 1365 cases (42.3%). Of these, 171/1365 patients (12.5%) were admitted and 29/1365 patients (2.1%) required surgical intervention (mean age, 14.5y±2.88y; range, 6.4y–17.8y). Sports included: eight football (28%), seven wrestling (24%), five gymnastics (17%), four diving (14%), two trampoline (7%), one hockey (3%), one snowboarding (3%), and one biking injury (3%). Mechanisms were 19 hyperflexion (65%), eight axial loading (28%), and two hyperextension injuries (7%). The majority of operative CSI were fractures (79%) and/or subaxial defects (72%). Seven patients (30%) sustained SCI and three patients (10%) spinal cord contusion or myelomalacia without neurologic deficits. The risk of SCI increased with age (15.8y vs. 14.4y; p=0.03) and axial loading mechanism (71% vs. 14%; p=0.003).Postoperatively, two SCI patients (29%) improved 1 ASIA Grade and one (14%) improved 2 ASIA Grades. Increased complications developed in SCI than patients without SCI (mean, 2.0 vs 0.1 complications; p=0.02). Clinical and radiographic fusion occurred in 24/26 patients (92%) with adequate follow-up (median, 32 months). Ten patients returned to their previous activity and nine to sports with a lower level of activity.Conclusion:The overall incidence of sports-related operative CSI is low. Age- and gender discrepancies exist, with male adolescent athletes most commonly requiring surgery. Hyperflexion injuries had a good prognosis; however, older males with axial loading CSI sustained in contact sports were at greatest risk of SCI, complications, and permanent disability.Figure 1.1:Etiology of all cervical spine injuries between 2004-2019

Management of Traumatic Central Cord Syndrome with Ossification of Posterior Longitudinal Ligament and Congenital Narrowing of Canal Stenosis: A case report

Background. Ossification of the posterior longitudinal ligament (OPLL) is a time bomb cervical disease characterized as a bony occupation in the narrowed canal which frequently presenting no symptoms. Traumatic central cord syndrome (TCCS) is the most frequent incomplete neck injury. The symptoms include a disproportionately more significant motor deficit of upper limbs than lower limbs with varying degrees of sensory loss below the level of the lesion and sacral sparing with or without bladder involvement. TCCS is often associated with hyperextension injury of the cervical spine and might occur after minor trauma without bony injury in patients with preexisting pathology of cervical spondylosis (CS) or canal stenosis. This article reported a case of TCCS with OPPL and congenital narrowing of canal stenosis. Method. We reported a case of a man 55 years old with spinal cord injury central cord syndrome type with disproportionate paresis, congenital cervical canal stenosis, ossifications of the posterior longitudinal ligament. We closed the comminuted fracture of the left clavicle. The patient underwent decompression surgery by laminoplasty on C3-C6 and open reduction with plate screw fixation on the left clavicle. Results. One week post-operation, the patient felt improvement on upper and lower motor function with increased sensitivity. Conclusion. Despite the controversies between surgery and conservative management regarding the treatment of cervical spine injuries with congenital canal stenosis and ossification of posterior longitudinal ligament, we found the decompression and laminoplasty giving positive results to patients.

Clinical observation of anterior cervical decompression and titanium mesh with locking plate fixation for treatment of cervical spondylosis

Objective To investigate the clinical effect of anterior cervical decompression and titanium mesh with locking plate fixation in the treatment of cervical spondylosis. Methods From January 2015 to January 2016, 58 patients with cervical spondylosis in Zhoushan Hospital of Traditional Chinese Medicine were selected and randomly divided into two groups, with 29 cases in each group.The control group received the anterior cervical decompression and autogenous iliac bone graft with locking plate fixation.The observation group received anterior cervical decompression and titanium mesh with locking plate fixation.The operation time, bleeding volume and postoperative complications were recorded in the two groups.The patients were followed up for 1 year after operation, the recovery of neurological function was evaluated by JOA standard, and the bone graft fusion rate was compared between the two groups. Results The operation time, blood loss of the observation group were (80.12±5.13)min, (61.45±3.75)mL, respectively, which were significantly less than those of the control group, the differences were statistically significant (t=2.956, 2.254, all P<0.05). The incidence rate of postoperative complications in the observation group was 6.90%, which was significantly lower than 24.14% in the control group, the difference was statistically significant (χ2=8.540, P<0.05). The postoperative JOA score of the observation group was (88.95±10.41)points, which was significantly higher than (82.11±7.03)points of the control group, the difference was statistically significant (t=2.192, P<0.05). After 1 year follow-up, the fusion rate of the observation group was 96.55%(28/29), which of the control group was 93.10%(27/29), the difference was not statistically significant (χ2=2.862, P=0.090). Conclusion Anterior cervical decompression and titanium mesh with locking plate fixation in the treatment of cervical spine injury has good curative effect, and has the advantages of small trauma and high bone fusion rate. Key words: Cervical spine injury; Anterior approach; Decompression; Titanium mesh; Internal fixators; Haemorrhage; Complication

Relationship between facet joint distraction during anterior cervical discectomy and fusion for trauma and functional outcome.

The purpose of this retrospective study was to investigate the clinical relevance of increased facet joint distraction as a result of anterior cervical decompression and fusion (ACDF) for trauma. A total of 155 patients (130 men, 25 women. Mean age 42.7 years; 16 to 87) who had undergone ACDF between 1 January 2001 and 1 January 2016 were included in the study. Outcome measures included the Neck Disability Index (NDI) and visual analogue scale (VAS) for pain. Lateral cervical spine radiographs taken in the immediate postoperative period were reviewed to compare the interfacet distance of the operated segment with those of the facet joints above and below. There was a statistically significant relationship between greater facet distraction and increased NDI and VAS pain scores. This was further confirmed by Spearman correlation, which showed evidence of a moderate correlation between both NDI score and facet joint distraction (Spearman correlation coefficient 0.34; p < 0.001) and VAS score and facet distraction (Spearman correlation coefficient 0.52; p < 0.001). Furthermore, there was a discernible transition point between outcome scores. Significantly worse outcomes, in terms of both NDI scores (17.8 vs 8.2; p < 0.001) and VAS scores (4.5 vs 1.3; p < 0.001), were seen with facet distraction of 3 mm or more. Patients who went on to have a posterior fusion also had increased NDI and VAS scores, independent of facet distraction. After undergoing ACDF for the treatment of cervical spine injury, patients with facet joint distraction of 3 mm or more have worse NDI and VAS pain scores. Cite this article: Bone Joint J 2018;100-B:1201-7.

Anterior Cervical Decompression, Fusion, and Stabilization by Cervical Plate and Screw for Traumatic Lower Cervical Spinal Injury: A Series of 62 Patients

IntroductionAcute cervical spinal injury is one of the most common causes of severe disability and death following trauma. Though treatment of cervical spine injury is controversial but anterior cervical surgery has still a better outcome then any other method. Material and MethodsA prospective study was done in NITOR and other private clinics at Dhaka from July 2009 - September 2014. Discectomy or corpectomy was done for decompression, tricortical bone graft or cage with bone graft was used for fusion. Cervical plate was used in all. Total case was 62 (M-46, F-16). Age ranging from 14 – 52 years. Total follow up time was 3 Months to 48 Months. Quantification of deficit and neurological outcome was rated by ASIA impairment scale. ResultsThe results shows that peak incidence was in 3rd decade. Falling due to slip while carrying heavy load on head was the most common cause. The commonest skeletal level was C5/C6. Among 62, during the pre operative period, 6 patients had ASIA impairment scale A, 25 patients had ASIA impairment scale B, 28 had ASIA impairment scale C & 3 had ASIA impairment scale D. At follow up, 22 of ASIA B changed to ASIA D, 3 of ASIA B changed to ASIA E, 18 of ASIA C changed to ASIA D, 10 of ASIA C changed to ASIA E, 3 of ASIA D changed to ASIA E & 6 of ASIA A remain unchanged. None had worsening of neurodeficit due to surgery. ConclusionFor better outcome, proper selection of case is very important. As no neurological recovery occurs in complete lesion but for early mobilization and prevention of further complication- surgery may be considered.

Skull traction for cervical spinal injury in Enugu: A 5-year retrospective multicenter analysis of the clinical outcomes of patients treated with two common devices.

Treatment of cervical spine injury is the most challenging of all the injuries of the spine, and there is yet no agreement on the best method of care. We studied the complications and outcome of two skull traction devices used to treat cases of cervical spine injury in three centers in Enugu, South East Nigeria. A retrospective analysis of patients with cervical spine injury managed with skull traction as the definitive treatment using either Crutchfield or Gardner-Wells tongs over a 5-year period (April 2008-March 2013). The traction was applied for 6 weeks, and the patient was subsequently mobilized with either hard cervical collar or Minerva jacket for another 6 weeks. One hundred and five patients with complete records out of 127 cervical spinal injured patients treated were studied. Forty-one had the American Spinal Injury Association (ASIA) Grade A whereas 64 had incomplete cord injury of ASIA Grades B-E. Forty-eight had Crutchfield traction whereas 57 had Gardner-Wells traction. At the end of treatment, no patient improved among those with ASIA Grades A and B. All the 12 cases of mortality were recorded as well among ASIA A (n = 9) and B (n = 3) Grades. Over 50% of ASIA Grades C and D patients improved to Grade E. The complication profile varied significantly between the traction subgroups with those treated using Crutchfield tongs experiencing more events (χ2 = 6.5, df = 1, P< 0.05). However, there was no significant statistical difference in the Association Impairment Scale (AIS) outcome (P = 0.55) as well as mortality rates (χ2 = 0.97, DF = 1, P> 0.05) between those treated with Crutchfield and Gardner-Well traction. Crutch field tong traction may be associated with more complications when compared with Gardner-Wells traction. However, from our study, the final American Spinal Injury AIS outcome, as well as the overall mortality rates associated with the two traction techniques, did not vary significantly.

The Cervical Trauma in Children: Difficulties in Diagnosis and Treatment Choice

Cervical traumas in children are often misunderstood and treated incorrectly. Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine leads to a different distribution of injuries and distinct radiographic features. The treatment of cervical spine injuries in children must be founded on an understanding of spine development. Differences in injury patterns, interpretation of radiographic studies, and management of injuries are a direct result of the unique anthropometrics and biomechanics of a child. The literature specifically addressing cervical spine injuries in children is scarce most studies have been focused on adults. In more recent years, as distinct aspects of the pediatric spine have been better appreciated, more attention has been given exclusively to injuries of the cervical spine in younger patients. We describe two cases of cervical trauma of different entity for which the incorrect evaluation of the trauma led to a difficult diagnostic-therapeutic path.

Surgery for Cervical Spine Injury Associated with Vertebral Body Fracture

Surgery for Cervical Spine Injury Associated with Vertebral Body Fracture Cervical vertebral body fracture is the result of cervical flexion with axial loading or simple axial loading. Although a minor fracture is often treated with a cervical collar or brace, a more severe or complex fracture may require surgical corrective reduction and/ or spinal fixation. We present our novel for surgical treatment of cervical spine injury associated with vertebral body fracture. We included 16 consecutive patients who underwent surgery because of cervical spine injury associated with vertebral body fracture.

Does CT Angiography Matter for Patients with Cervical Spine Injuries?

Cervical injury can be associated with vertebral artery injury. This study was performed to determine the impact of computed tomography (CT) angiography of the head and neck on planning treatment of cervical spine fracture, if these tests were ordered appropriately, and to estimate cost and associated exposure to radiation and contrast medium. This retrospective review included all patients who underwent CT of the cervical spine and CT angiography of the head and neck from January 2010 to August 2011 at one institution. Patients were divided into those with and those without cervical spine fracture seen on CT of the cervical spine. We determined if the CT angiography of the head and neck was positive for vascular injury in the patients with a cervical fracture. Vascular injury treatment and alterations in surgical fracture treatment due to positive CT angiography of the head and neck were recorded. A scan was deemed appropriate if it had been ordered per established institutional protocol. Of the 381 patients who underwent CT angiography of the head and neck, 126 had a cervical injury. Sixteen of the CT angiography studies were appropriately ordered for non-spinal indications, and twenty-three were inappropriately ordered. The CT angiography was positive for one patient for whom the imaging was off protocol and one for whom the indication was non-spinal. Nineteen patients had positive CT angiography of the head and neck; no patient underwent surgical intervention for a vascular lesion. Eleven patients underwent surgical intervention for a cervical fracture; the operative plan was changed because of vascular injury in one case. The CT angiography was positive for eleven of forty-eight patients who had sustained a C2 fracture; this group accounted for eleven of the nineteen positive CT angiography studies. Noncontiguous injuries occurred in nineteen patients; three had positive CT angiography of the head and neck. The approximate charge for the CT angiography was $3925, radiation exposure was approximately 4000 mGy/cm, and contrast-medium load was approximately 100 mL. Positive CT angiography of the head and neck rarely altered surgical treatment of cervical spine injuries. This study supports the findings in the literature that C1-C3 spine injuries have an increased association with vertebral artery injury. CT angiography of the head and neck ordered off protocol had a low likelihood of being positive. Strict adherence to protocols for CT angiography of the head and neck can reduce costs and decrease unnecessary exposure to radiation and contrast medium. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Management of Unstable Cervical Spine Injuries

Injuries to the cervical spine can cause potentially devastating morbidity and even mortality. In this review we discuss the anatomy and biomechanics of the cervical spine. The evaluation and treatment of cervical spine injuries begins with the prompt immobilization of suspected injuries in the field. Once an assessment of the patient's neurological status is made, imaging studies are obtained, which can include X-rays, CT, and MRI. Careful scrutiny of the imaging studies for bony and/or ligamentous injury allows the physician to determine the mechanism of injury, which guides treatment. The ultimate treatment plan can consist of non-operative or operative management, and depends on patient specific factors (medical condition and neurological status), the mechanism of injury, and the resultant degree of instability. With prompt diagnosis and appropriate management, the morbidity of these injuries can be minimized.

Frontolateral pins for halo ring placement: reassessment of a common neurosurgical procedure with CT measurements of skull thickness

Halo orthosis placement is a common neurosurgical procedure for the treatment of cervical spine injuries. Frontal sinus puncture by the anterior pins may occur using standard techniques, and up to 30% are dissatisfied with forehead scarring, especially women and African Americans. The authors describe a frontolateral (FL) anterior pin site placement supported by high-resolution CT scan skull thickness measurements. The standard supraorbital (SO) pin site is several centimeters above the lateral orbit, whereas the FL pin site is 2-3 cm posterolateral to the SO site. Frontolateral placement is just anterior to the temporalis muscle close to a triangular anterior projection of the temporal hairline. For quantitative information on skull thickness at the SO and FT pin sites, thin 0.625-mm CT scan measurements of the outer table, diploic space, and inner table were obtained in 40 adults (80 sites). The mean values for total skull thickness at the SO and FT sites were not significantly different. The inner table was significantly thicker at the FL site in both males and females, buttressed by the nearby greater sphenoid wing. The mean total skull thickness was significantly less in females than in males, but the values were not significantly different at the SO and FL sites. The FL and SO anterior pin sites are comparable with respect to skull thickness CT measurements, with a significantly thicker inner table at the FL site. In the senior author's experience, the FL anterior pin site yielded secure fixation without skull perforation, neurovascular injury, or propensity to infection. The cosmetic result of the FL site is more acceptable, and the authors recommend its general usage be adopted.

A Validated Classification for External Immobilization of the Cervical Spine

Study Design Interobserver and intraobserver reliability study. Objective The aim of this study is to validate a new classification system of external cervical spine immobilization devices by measuring the interobserver and intraobserver agreement. Methods A classification system, with five main categories, based on the anatomical regions on which the device supports, was created. A total of 28 independent observers classified 50 photographs of different devices, designed to immobilize the cervical spine according to the new proposed classification system. At least 2 weeks later, the same devices were classified again in a new random order. Before and after the classification, all the participants answered questions about the usefulness of the proposed classification. Results The mean interobserver and intraobserver agreement Fleiss' kappa was 0.88 and 0.91, respectively. Both are, according to the interpretation described by Landis and Koch, “almost perfect.” A majority of the participators answered that they needed a classification (89%) and considered the classification to be clear (96%). All the participants considered the classification to be useful in clinical practice. Conclusion This study showed that the new classification of external cervical spine immobilizers, based on anatomical support areas, has an excellent interobserver and intraobserver agreement. Furthermore, the study participants considered the proposed classification to be clear and useful in clinical practice. As the majority of patients with cervical spine injuries are treated with external immobilization devices, this new classification system can improve the closed treatment of cervical spine injuries in daily clinical practice. Furthermore, it makes reproducible comparisons between groups possible, which are essential for further evolution of evidence-based spine care.

Methodological Systematic Review: Mortality in Elderly Patients With Cervical Spine Injury

Methodologic systematic review. To determine the validity of reported risk factors for mortality in elderly patients with cervical spine injury. In elderly patients with cervical spine injury, mortality has frequently been associated with the type of treatment. To date, however, no review evaluating the validity of reported risk factors for mortality in elderly patients with cervical spine injury has been published. Studies evaluating the treatment of cervical spine injuries in elderly (>/=60 years of age) patients were searched through the Medline and EMBASE databases. In addition to standard methodologic details, reporting of putative confounding baseline characteristics and analysis of risk factors for mortality were appraised critically. For this purpose, patient data presented in included studies were pooled. Exploratory descriptive statistics were used for data analysis. Twenty-six eligible studies were identified, including a total of 1550 pooled elderly subjects. Except for 2, all studies reported presence or absence of spinal cord injury. Details concerning the severity and/or extent of the injury were reported in 12 (46%) studies. Pre-existing comorbidities were reported in 9 studies (35%). In the pooled subjects, the cause of death was not reported in 155 of 335 deceased patients (42%). Based on own results, 18 (69%) studies reported on risk factors for mortality. Of these studies, 6 (23%) performed statistical analyses of risk factors for mortality outcomes. Only 1 study statistically adjusted potential risk factors for mortality for confounding. Overall, pre-existing comorbidities, concomitant injuries, follow-up and cause of death have been underreported in studies investigating the treatment of cervical spine injuries in elderly patients. To strengthen the validity of risk factors for mortality in future clinical trials, adjustments for appropriately reported putative confounders by regression analysis are mandatory.

Frakturen der Halswirbelsäule

Due to the high incidence of concomitant neurological lesions, standardized clinical and radiologic diagnostic procedures in cervical spine injuries are mandatory. Magnetic resonance imaging or a stress X-ray should be performed when discoligamentous injuries are suspected. The three most important pillars in the treatment of cervical spine injuries are the surgical indication, the surgical approach and the choice of implant. However, despite prompt and appropriate therapy many of these injuries lead to permanent functional impairment depending on the type of fracture. This article summarizes the most frequent fracture types of the cervical spine, as well as the corresponding therapeutic options and outcome.

Posterior cervical spine arthrodesis incorporating C2laminar screw fixation in the treatment of cervical spine injury

To investigate the clinical application and efficacy of an internal fixation technique incorporating C(2) laminar screws for upper cervical spine injury. Using a posterior cervical approach, incorporating C(2) laminar screw fixation and bone grafting were performed on 20 patients with cervical spine injury. There were 12 male and 8 female patients, with a mean age of 45.6 years (range, 32-71 years). All patients were evaluated by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI). The patients were followed up for 11-35 months (mean, 15 months), and bony union was achieved in all patients. There were no spinal cord or vertebral artery injuries during surgery, and only two instances of vein clump injury, in both of which the bleeding was controlled successfully. Postoperative CT scans showed that all the C(2) laminar screws had been placed properly, and were not encroaching on the spinal canal. No spinal instability, evidence of hardware failure or screw loosening was found during the follow-up period in any patient. Crossing C(2) laminar screw internal fixation technique is simple, and is not limited by the position of the vertebral artery in the body of C(2). The laminar screw method avoids arterial injuries and also can be used as a salvage method after previous misinsertion. As all relevant structures are directly visualized during C(2) laminar screw placement, this kind of technique may be applicable to a large number of patients.