We use cookies to offer you a better experience, personalize content, tailor advertising, provide social media features, and better understand the use of our services. Accurate diagnosis of acute cervical spine injury requires cooperation. Pdf basic principles of management for cervical spine trauma. Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading epidemiology. One method to classify thoracic andor lumbar spinal fractures. The spinal fracture service is led by three of our consultant orthopaedic spine surgeons and are supported by our senior spinal nurse practitioners, physiotherapists, orthotists and occupational therapists what is a vertebral fracture. Cervical spine injuries are found in about 2% to 3% of all blunt trauma victims. Fractures of the cervical spine are potentially serious and devastating if not properly treated. Guideline on the management of alert, adult patients with. A vertebral fracture is a break to one of the bones in your spine. Spinal stabilization and management zprotect spine at all times during the management of patients with multiple injuries. Nerves in the spinal cord control your ability to move. This case report describes a hyperextension injury of the neck in a patient unknown to have dish, which resulted in an angulated c3c4 fracture. Traumatic injuries of the cervical spine c spine are uncommon in children.
Jul 01, 2016 vertebral compression fractures vcfs are the most common complication of osteoporosis, affecting more than 700,000 americans annually. Fracture management overview history who, what, when, where, why o who age, job, hobbies, hand dominance if hand involved, cognition amts score if elderly o what happened and exactly how it happened mechanism of injury force involved likelihood of other structure damage o when it happened o where it happened o why. The study showed that plain radiography failed to detect cervical spine fractures in 208 from 278 patients suffering from cervical spine fracture, 74. Academic department of critical care queen alexandra hospital.
The canadian c spine rule clinically clears cervical spine fracture without imaging. The methods and technology used to diagnose and classify these injuries as well as medical. Cervical spine fractures radiology reference article. Nationalathletictrainersassociationposition statement. This is an enhanced pdf from the journal of bone and joint surgery j bone joint surg am. Cervical spine fractures associated with diffuse idiopathic hyperostosis dish are less common than those associated with ankylosing spondylitis and can occur after minor trauma in patients asymptomatic of the disease process. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical spine ct, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings. Cspine injuries can have serious consequences including death or permanent tetraplegia1. This article focuses on fractures of the thoracic spine midback and lumbar spine lower back that result from a highenergy event, such as a car crash or a fall from a ladder. The 15 year experience at one pediatric trauma centre. Case 1 37 yo f sp high speed mva restrained passenger azam basheer 4. However, it is typical to assume there is a cervical spine injury until examination andor radiological investigation demonstrate otherwise. The canadian c spine rule 11, 12 the canadian c spine rules are designed for alert and stable trauma patients. It is the dedication of healthcare workers that will lead us through this crisis.
The outcome of a catastrophic cervical spine injury depends on the efficiency of this manage. Many of these injuries will never require surgery, but major fractures can result in serious longterm problems unless treated promptly and properly. Define whether any high risk factors are present such as age. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. The canadian cspine rule clinically clears cervical spine fracture without imaging. The unique anatomy and relationship of the atlas and axis vertebra result in a variety of fracture patterns in the setting of significant cervical trauma. Most cervical spine fractures occur predominantly at 2 levels. Spine trauma and management cpt samuel rocker, apa c lcdr ari doucette, pa c. Urgent requirement to identify a cervical spine fracture eg prior to surgery. Vertebral compression fractures vcfs are the most common complication of osteoporosis, affecting more than. The cervical spine is divided into the upper cervical spine occiputc2 and the lower cervical spine c3c7, according to anatomical differences. Brodke, mitchel harris, jens chapman, thomas schildhauer, m.
Fractures of the thoracic and lumbar spine orthoinfo aaos. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. There is a gradual change in the acceptability of halo jacket treatment for unstable cervical spinal injuries and much as the management of tibial fractures has migrated from a nonoperative treatment approach to operative stabilisation, there is a similar shift in trends for managing unstable cervical spine injuries. The nexus criteria for c spine imaging clears patients from cervical spine fracture clinically, without imaging.
Falls, motor vehicle collisions, pedestrian accidents, cycling and diving are common causes of injury 6,7 pathology. Cervical fracture aftercare instructions what you need. Halo falling out of favor for collar with nonoperative treatment rockwood and. Epidemiology, injury mechanisms and pathobiomechanics. Evaluation and initial management of cervical spinal column injuries in adults. Even minor falls or trauma can produce a spine fracture.
Diagnosis and management of vertebral compression fractures. If this is the case, an xray of the cervical spine. The initial management of spine fractures requires strict adherence to the clinical condition and the presence and severity of neurologic dysfunction. The most commonly missed spinal fracture is the second one. Fracture risk increases with age, with four in 10 white.
Urgent requirement to identify a cervical spine fracture eg prior to surgery level five evidence. If the spine is not in a neutral position, rescuers should realign the cervical spine to minimize secondary injury to the spinal cord and to allow for optimal airway management. Acute management of traumatic cervical spinal cord injury. Aug 18, 2017 although mechanically stable, it is associated with lifethreatening atlantooccipital dislocation. Assessment and clearance of the cervical spine the management of severe traumatic brain injury the reversal of oral anticoagulants, the timing of antibiotic administration, and time to the operating room for open fracture management vte prophylaxis. Diagnosis and management of sacral spine fractures this information is current as of april 9. Diagnosis and management of thoracic spine fractures. Teardrop fractures of the cervical spine are defined as fractures involving the anteroinferior angle of the cervical vertebral body, with the vertical dimension of the triangular fragment being equal to, or greater than the transverse dimension1. Classification and surgical management for the axis fracture. Aug 22, 2009 traditionally, management of injuries of the cervical spine have been a bolton extra in managing the multiply injured patient, but the widespread adoption of the advanced trauma life support protocols has highlighted the importance of assuming a cervical spine injury in all patients with a history of trauma until proven otherwise. The guideline should be read alongside the nice guidelines on major trauma, complex fractures, fractures and major trauma. Cervical fractures usually result from highenergy trauma, such as automobile crashes or falls. Thoracic compression fractures albany medical college. This method divides the lateral side spine into three sections.
An xray will help to determine if a transverse fracture or another type of spinal fracture has occurred, but theres also the possibility that youll undergo an mri or ct scan to look for any soft tissue damage. The nexus criteria for cspine imaging clears patients from cervical spine fracture clinically, without imaging. Although cervical spine trauma is more common following high velocity mechanisms of injury resulting in multiple injuries, falls and low velocity mechanisms may also result in serious cervical spine injury. They support the head and connect it to the shoulders and body. Surgeons must ensure adequate removal of bone and ligament to relieve any compression on the neural elements. Increased attention to critical care support has led to improved survival and recovery in many patients. Three column concept of spinal fractures radiology. Thoracic spine fractures are relatively rare in comparison to fractures of the cervical, lumbar, and thoracolumbar regions. Apr 01, 2015 upper cspine fractures azam basheer 1. Early and consistent attention to the possibility of a spinal column injury will facilitate safe and effective treatment of the multiple injured patients.
Conservative fracture immobilisation options fracture conservative management options torso cervical spine cervical collar or traction e. Protect spine at all times during the management of. Basic principles of management for cervical spine trauma. These injuries may result in motor and sensory deficits and also in cardiovascular and respiratory perturbations. These tips can reduce your discomfort and gently guide you back into your normal activities. Airway management in adults after cervical spine trauma. Musculoskeletal s tructures and f unction the s keletal s tructures modern orthopaedics is concerned with the diagnosis and management of disorders of the musculoskeletal system, that is the skeleton and.
Approximately 510% of unconscious patients who present to the ed as the result of a motor vehicle accident or fall have a major injury to the cervical spine. Upper cervical spine trauma orthopaedic trauma association. What are the types of odontoid process fractures of the. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlantoaxial dislocations, fractures of the odontoid process, and hangmans fractures in the c2 segment. The cervical vertebrae are the smallest of the moveable vertebrae, and are characterized by a foramen in each transverse process. B type ii odontoid fracture is a fracture at the base of the dens. You are starting to heal from a vertebral compression fracture broken bone in the spine.
The importance of the role of postinjury rehabilitation is identified. The causes of injury included traffic injuries in 18 patients, fall injury. Several studies suggest that c spine radiography may not have adequate sensitivity to rule out spine fracture, especially in the elderly. It includes assessment for all gcs 15 patients age 65 with a dangerous mechanism or parenthesis in the. It is often challenging to assess and immobilise children when a c spine injury is suspected. Management of acute combination fractures of the atlas and axis. The cervical spine cspine is the most common site for spinal fractures. Cervical vertebrae support your head and allow your neck to bend and twist. C with type iii odontoid fracture, the fracture line extends into the body of the axis. Fractures of the cervical spine pubmed central pmc. Use good body mechanics and maintain the normal curves in your spine. The 3 types of odontoid process fractures are classified based on the anatomic level at which the fracture occurs see the image below.
Due to its simplicity, it is widely used in routine clinical practice and can be used in reports with the expectation that involved treating. It is important to correctly classify the fracture to ensure appropriate treatment. Upper cspine fractures azam basheer md henry ford neurosurgery 2. One method doctors use to classify a spinal fracture in the thoracic, lumbar or thoracolumbar regions of the spine is the denis classification method.
Patients with acute cervical spinal cord injury present complex clinical challenges. These types of fractures are typically medical emergencies that require urgent treatment. A cervical fracture is a break in a vertebra bone in your neck. A fracture, or break, in one of the cervical vertebrae is commonly called a broken neck. Outline epidemiology anatomy common injuries management and surgical approaches azam basheer 3. Several studies suggest that c spine radiography may not have adequate sensitivity to rule out spine fracture. Aims clinical appropriateness guidelines hereinafter aims clinical appropriateness guidelines or the. Evaluation and acute management of cervical spine injuries in children and adolescents. It aims to reduce death and disability by improving the quality of emergency and urgent care. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. Dormans high incidence of noncontiguous spine fractures in children. While the threecolumn concept was initially developed for classification of thoracolumbar spinal fractures, it can also be applied to the lower cervical spine 3 as the general vertebral anatomy is similar to thoracic and lumbar vertebrae. Thoracic compression fractures a patients guide to thoracic compression fractures introduction the bones, or vertebrae, that make up your spine are very strong, but sometimes a vertebra can fracture just like any other bone in your body.
Surgical management of thoracic spine fractures before introduction of the harrington internal fixation system in the 1960s was limited to laminectomy and often associated with neurological deterioration secondary to spinal cord manipulation or increased instability. Background failure to diagnose unstable fractures or ligamentous injuries in the cervical spine can result in irreversible. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury resulting in loss of sensation, paralysis, or usually instant death. Trauma clinical guideline cervical spine injury evaluation. It covers traumatic injuries to the spine but does not cover spinal injury caused by a disease. The signs and symptoms of spinal compression fractures can come on gradually and vary from person to person. Safe management of acute cervical spine injuries efort open. Males are affected more commonly than females with the median age of injury being 56 years. A low gcs indicates a high risk for a concomitant cervical injury. Webmd tells you what to look for especially if youre a woman with osteoporosis. This article describes the assessment and management of potential cervical spine injury in the primary care setting. Ct is the preferred technique for certain clinical scenarios such as suspected fracture, followup of known fracture, osseous tumor evaluation and congenital vertebral defects, as well as procedures such as cervical spine ct myelography do not use ct cervical spine for imaging of the soft tissues of the neck. This topic discusses the evaluation and initial management of injuries to the cervical spinal column in adults, including how to determine the need for imaging. Basic principles of management for cervical spine trauma ncbi.
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