Cervical Spine Injuries - Chinmay Gupte 27/8/2001

Epidemiology (US)

Annual incidence SCI:                          5 per 100,000

1 yr mortality rate (Mesard, 1978):                   28% for complete SCI

                                                                        14% for incomplete SCI

Issues of interest

[1]         Pre-hospital care: extrication (Karbi; CMAJ 1998):     devices should be easily applied facilitate extrusion from car seats without changing body position, or hindering the airway.

[2]         Immobilisation:   collar, sandbags and tape (above article discusses new methods but none as yet established)

[3]         Radiographic evaluation:

 

X-Rays:

most agree on 3 view series ie. Open mouth+lateral+AP views.

                                                                                               

View    

Look for

Doubt

Open mouth

lateral masses of C1/C2

Jefferson fracture (lateral displacement of lateral masses)

 

Odontoid peg

Peg fracture (types I-III)

Lateral

Alignment, Bones, disC spaces, Soft tissues

Atlanto axial subluxation (widening of atlatoaxial space >3mm)

Hangman’s (spondylolisthesis C2)

Burst fractures (disrupted contour of posterior vertebral line)

Others incl. Wedge fractures/ligamentous injuries/locked facets

AP

Spinous process alignment/distance; vertebral bodies

Unilateral locked facets

 

Other views:     swimmers views for C7/T1

2 supine oblique views are also of benefit

 

CT scanning/ MRI imaging:

ACR have devised a protocol for usefulness of each imaging modality


Kathol, MH.   Cervical spine trauma, what is new?   Radiologic clinics of North America 1997; 35 (3) 507-533.

Patient group

Radiologic examination

Score of appropriateness

Asymptomatic patiens with normal physical   examination

3 view X-ray

 

1

Symptomatic patients

3 view X-ray

9

Symptomatic patients in whom ligamentous injury is suspected with N plain films

Flexion/extension radiographs

CT scan

MRI

9

 

1

1

Neurological signs c normal plain films

MRI

CT

Flexion/extension

9

9

1

?injury to occiput at C2 level

CT

CT with reformatting

MRI

9

9

1



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