Unstable Multi-Level Ligamentous Injury of the Cervical Spine in an Adolescent

Abstract The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Fifth Edition, defines a motion segment as “two adjacent vertebrae, the intervertebral disk, the apophyseal or facet joints, and ligamentous structures between the vertebrae.” The range of motion from segment to segment varies, and loss of motion segment integrity is defined as “an anteroposterior motion of one vertebra over another that is greater than 3.5 mm in the cervical spine, greater than 2.5 mm in the thoracic spine, and greater than 4.5 mm in the lumbar spine.” Multiple etiologies are associated with increased motion in the cervical spine; some are physiologic or compensatory and others are pathologic. The standard radiographic evaluation of instability and ligamentous injury in the cervical spine consists of lateral flexion and extension x-ray views, but no single pattern of injury is identified in whiplash injuries. Fluoroscopy or cineradiographic techniques may be more sensitive than other methods for evaluating subtle abnormal motion in the cervical spine. The increased motion thus detected then must be evaluated to determine whether it represents normal physiologic motion, normal compensatory motion, motion related to underlying degenerative disk and/or facet disease, or increased motion related to ligamentous injury. Imaging studies should be performed and interpreted as instructed in the AMA Guides.

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In Vitro Comparison of a Translational Anterior Cervical Plate With a Constrained Anterior Cervical Plate

10.1115/imece2001/bed-23036 ◽

2001 ◽

Author(s):

Denis J. DiAngelo ◽

Weiqiang Liu ◽

Kristine M. Olney ◽

Kevin T. Foley

Keyword(s):

Cervical Spine ◽

Cervical Spondylosis ◽

Load Transfer ◽

Multi Level ◽

Cervical Plate ◽

Degenerative Disorder ◽

Anterior Cervical Plate ◽

Cervical Plating ◽

In Vitro Comparison

Abstract Cervical spondylosis is the most common degenerative disorder affecting the cervical spine and is often treated surgically to prevent further neurological deterioration. However, clinical experience has shown that anterior cervical plating does not prevent construct failure in multi-level cervical corpectomy (Vaccaro et al., 1998). We have previously shown that anterior cervical plating reverses the load transfer through multi-level strut-grafts and may promote pistoning of these grafts (DiAngelo et al., 2000). The design of the anterior cervical plate (ACP) may contribute to this phenomenon. The purpose of this study was to compare the graft loading mechanics of two different anterior cervical plating systems; one with a constrained plate-screw interface versus another with a semi-constrained, translational plate-screw interface.

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Prevertebral Soft-Tissue Swelling at C7 Is Highly Sensitive for Cervical Spine Ligamentous Injury Study Type: Retrospective Cohort Study

JAAOS Global Research and Reviews ◽

10.5435/jaaosglobal-d-19-00093 ◽

2020 ◽

Vol 4 (4) ◽

pp. e19.00093

Author(s):

Jonathan C. Savakus ◽

Douglas S. Weinberg ◽

Timothy A. Moore ◽

Heather A. Vallier

Keyword(s):

Cohort Study ◽

Cervical Spine ◽

Soft Tissue ◽

Retrospective Cohort ◽

Ligamentous Injury ◽

Highly Sensitive ◽

Soft Tissue Swelling ◽

Prevertebral Soft Tissue ◽

Study Type ◽

Prevertebral Soft Tissue Swelling

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In Reply to the Letter to the Editor Regarding “Adjacent Level Ligamentous Injury Associated with Traumatic Cervical Spine Fractures: Indications for Imaging and Implications for Treatment”

World Neurosurgery ◽

10.1016/j.wneu.2015.10.017 ◽

2016 ◽

Vol 86 ◽

pp. 7

Author(s):

Basem I. Awad ◽

Daniel Lubelski ◽

Michael P. Steinmetz

Keyword(s):

Cervical Spine ◽

Spine Fractures ◽

Adjacent Level ◽

Ligamentous Injury ◽

Letter To The Editor ◽

Cervical Spine Fractures

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Fixation of Fractures of the Lower Cervical Spine Using Methylmethacrylate and Wire: Technique and Results in 99 Patients

Neurosurgery ◽

10.1227/00006123-198910000-00002 ◽

1989 ◽

Vol 25 (4) ◽

pp. 503-513 ◽

Cited By ~ 14

Author(s):

Charles L. Branch ◽

David L. Kelly ◽

Courtland H. Davis ◽

J. M. McWhorter

Keyword(s):

Pulmonary Embolism ◽

Cervical Spine ◽

Lower Cervical Spine ◽

Ligamentous Injury ◽

Fixation Failure ◽

Patient Morbidity ◽

Traumatic Fracture ◽

Superficial Wound ◽

Fracture Dislocations ◽

Posterior Element

Abstract Surgical stabilization of traumatic fracture-dislocations of the lower cervical spine with wire and methylmethacrylate remains a controversial procedure. Yet, the resultant immediate fixation with minimal patient morbidity seems to indicate that this method provides an ideal stabilization construct. We describe and report the outcome of a technique of posterior cervical fixation with methylmethacrylate and wire for stabilization of traumatic fractures of the lower cervical spine. Over a 12-year period, 124 fracture-dislocations of the lower cervical spine in 99 patients (mean age, 32 years; range, 15-76 years) were treated at this institution using a posterior methylmethacrylate and wire technique. Eighty-two patients had a posterior element fracture; 28 had a vertebral compression with posterior ligamentous injury; and 14 had a ligamentous injury alone. Thirty-six patients were neurologically intact upon admission, while the rest had radiculopathy or partial or complete myelopathy. Ninety-one patients were available for follow-up [mean, 18.6 months; range, 1-100 months (8.33 years)]. Eighty-eight patients (97%) had a stable fixation and 77 (85%) had resumed preoperative activity or were working but with a residual deficit. Complications included fixation failure requiring a second operation in 3 patients, nonlethal pulmonary embolism in 2 patients, lethal pulmonary embolism in 1 patient, and a superficial wound infection in 3 patients (none affected the underlying fixation construct). These results indicate that this technique is a safe, simple, and effective method for stabilizing the lower cervical spine that allows rapid patient mobility with minimal morbidity.

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Magnetic resonance imaging of ligamentous injury of the cervical spine

Emergency Radiology ◽

10.1007/bf01508159 ◽

1996 ◽

Vol 3 (1) ◽

pp. 9-15 ◽

Cited By ~ 23

Author(s):

Jean Warner ◽

K. Shanmuganathan ◽

Stuart E. Mirvis ◽

Donald Cerva

Keyword(s):

Magnetic Resonance Imaging ◽

Cervical Spine ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Ligamentous Injury

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Assessing Incidence and Risk Factors of Cervical Spine Injury in Blunt Trauma Patients Using the National Trauma Data Bank

The American Surgeon ◽

10.1177/000313481508100921 ◽

2015 ◽

Vol 81 (9) ◽

pp. 879-883 ◽

Cited By ~ 13

Author(s):

Andrew J. Young ◽

Luke Wolfe ◽

Glenn Tinkoff ◽

Therese M. Duane

Keyword(s):

Risk Factors ◽

Cervical Spine ◽

Injury Severity Score ◽

Blunt Trauma ◽

Severity Score ◽

Injury Severity ◽

Alcohol Intoxication ◽

Spine Injury ◽

Ligamentous Injury ◽

National Trauma

Despite the potentially devastating impact of missed cervical spine injuries (CI), there continues to be a large disparity in how institutions attempt to make the diagnosis. To better streamline the approach among institutions, understanding incidence and risk factors across the country is paramount. We evaluated the incidence and risk factors of CI using the National Trauma Databank for 2008 and 2009. We performed a retrospective review of the National Trauma Databank for 2008 and 2009 comparing patients with and without CI. We then performed subset analysis separating injury by patients with and without fracture and ligamentous injury. There were a total of 591,138 patients included with a 6.2 per cent incidence of CI. Regression found that age, Injury Severity Score, alcohol intoxication, and specific mechanisms of motor vehicle crash (MVC), motorcycle crash (MCC), fall, pedestrian stuck, and bicycle were independent risk factors for overall injury ( P < 0.0001). Patients with CI had longer intensive care unit (8.5 12.5 vs 5.1 7.7) and hospital lengths of stay (days) (9.6 14.2 vs 5.3 8.1) and higher mortality (1.2 per cent vs 0.3%), compared with those without injury ( P < 0.0001). There were 33,276 patient with only fractures for an incidence of 5.6 per cent and 1875 patients with ligamentous injury. Just over 6 per cent of patients suffer some form of CI after blunt trauma with the majority being fractures. Higher Injury Severity Score and MVC were consistent risk factors in both groups. This information will assist in devising an algorithm for clearance that can be used nationally allowing for more consistency among trauma providers.

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