Trauma cervical spine

Handel SF, Twiford TW Jr, Reigel DH, et al. (1979) Posterior lumbar apophyseal fractures. Radiology 130 629-633 Henderson RL, Reid DC, Saboe LA (1991) Multiple noncontiguous spine fractures. Spine 16 128-131 Hernandez JA, Chupik C, Swischuk LE (2004) Cervical spine trauma in children under 5 years productivity of CT. Emerg Radiol 10 176-178... 

Berlin L (2003) CT versus radiography for initial evaluation of cervical spine trauma what is the standard of care AJR Am J Roentgenol 180 911-915 Buckwalter KA, Rydberg J, Kopecky KK, Crow K, Yang EL (2001) Musculoskeletal imaging with multislice CT. AJR Am J Roentgenol 176 979-986... 

Immobilize cervical spine with an available device. Cervical spine injury is assumed in multiple trauma. 

Airway/cervical spine Assess for patency iook for ioose teeth, vomitus, or other obstruction note position of head. Suspect cervicai spine injury with muitipie trauma maintain neutrai aiignment during assessment evaiuate effectiveness of cervicai coiiar, cervicai immobiiization device, or other equipment used to immobiiize the spine. Open cervicai coiiar to evaiuate neck for juguiar vein distention and tracheai deviation. 

Most lesions causing Homer s syndrome involve the preganglionic neuron. Patients with such lesions may have an apical lung tumor (Pancoast tumor) or breast malignancy that has spread to the thoracic outlet. The patient may also have a history of surgery or trauma to the neck, chest, or cervical spine. Nonoperative injuries to... 

It is vitally important to be aware of the anatomical variants and normal developmental findings that may be present in the paediatric spine, as many of these can be confused with significant injury in the context of trauma. Imaging of the paediatric cervical spine presents a particular challenge since not... 

Lustrin ES, Karakas SP, Ortiz AO et al (2003) Pediatric cervical spine normal anatomy, variants and trauma. Radiographics 23 539-560... 

Paediatric spinal trauma is an uncommon form of injury. Spinal injuries in children and adolescents account for l%-9% of total reported spinal injuries. Spinal fractures represent l%-2% of all paediatric fractures and the cervical spine is the commonest region involved accounting for 60%-80% of paediatric spinal injuries (Kokoska et al. 2001). This in turn means that the average general radiologist and emergency physician is unlikely to see a significant number of paediatric spinal injuries and may there-... 

AARF can be traumatic or more commonly atraumatic. The commonest cause is idiopathic. Other causes include trauma, infection, surgery to the head and neck region, inflammatory arthropathy and congenital anomalies of the cervical spine. Most cases resolve spontaneously. In a few cases AARF becomes fixed and irreducible. Fielding and Hawkins (1977) classified AARF into four types (Fig. 20.9a-d)... 

Barba CA, Taggert J, Morgan AS, et al. (2001) A new cervical spine clearance protocol using computed tomography. J Trauma 51 652-656 discussion 656-7 Brant-Zawadzki M, Jeffrey RB Jr, Minagi H, et al. (1982) High resolution CT of thoracolumbar fractures. AJR Am J Roentgenol 138 699-704... 

Brower AC, Downey EF Jr (1981) Kummell disease report of a case with serial radiographs. Radiology 141 363-364 Brown RL, Brunn MA, Garcia VF (2001) Cervical spine injuries in children a review of 103 patients treated consecutively at a level 1 pediatric trauma center. J Pediatr Surg 36 1107-1114... 

Hoffman JR, Mower WR, Wolfson AB, et al. (2000) Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med... 

Hoffman JR, Wolfson AB, Todd K, et al. (1998) Selective cervical spine radiography in blunt trauma methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 32 461-469... 

Hogan GJ, Mirvis SE, Shanmuganathan K, et al.(2005) Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma is MR imaging needed when multi-detector row CT findings are normal Radiology 237 106-113... 

Whole-body CT (WB-CT) protocols in multisystem trauma usually consist of a non-contrast enhanced head CT, which is followed by a contrast-enhanced chest and abdominal CT. For evaluation of the spine, reformations from the chest and abdomen are of diagnostic image quality if the primary colUmation was 2.5 mm or less, and dedicated scans of the spine are not obligatory (Mann et al. 2003). The cervical spine can be scanned separately with thin coUimations after the head scan, or can be included in the chest scan. The latter option has the advantage that the cervical vessels are contrast-enhanced, and vascular injuries can be ruled out from the same dataset, sparing one additional scan. 

Evaluation of the cervical spine begins with a history of the patient s symptom and a thorough examination of the patient. A history of trauma to the neck is especially important. Pain and decreased range of motion are the most common complaints relative to the cervical spine. 

The cervical spine is frequently involved in trauma caused by the flexibility of the neck with a heavy head sitting atop the small vertebrae. With the rapid motion of modern vehicles, ac-celeration/deceleration injuries of the neck are quite common. As the neck is snapped forward and backward, the long muscles tend to have their fibers torn, with associated bleeding into the muscles. However, it is important to remember that "whiplash injury" is not a problem of the cervical spine alone, because the entire body has abnormal forces applied to it. Osteopathic manipulation is a major part of the treatment of the patient with whiplash injuries. 

Cervical spine fractures may result from translocation of the body and impact on landing or direct trauma arising from the impact of other translocated materials. Conventional treatment protocols should be followed. 

As with any trauma victim, the first priorities are establishment and maintenance of a patent airway with oxygenation (151/min) and cervical spine protection. The main thrust of blast limg management is to restore arterial blood gases to near normal and maintain them while recovery occurs. Corticosteroids are not indicated. 

Anterior wedging of the upper cervical bodies particularly C3 (Fig. 7.62) is a normal developmental variant and should not be confused with a compression injury. It may be the result of relative hypermobility of the spine during childhood and resolves with increasing maturity (Swischuk et al. 1993). Secondary ossification centres ( ring epiphyses or apophyses) appear at the superior and inferior aspects of all vertebral bodies and do not fuse with the vertebral body until early adulthood (Figs. 7.63, 7.64). These should not be mistaken for fractures, although they can be avulsed as a result of trauma (JOHNSSON et al. 1991). 

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