scholarly journals Cervical Spine Clearance: A Review and Understanding of the Concepts

2008 ◽  
Vol 47 (172) ◽  
Author(s):  
Amit Agrawal
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Pediatric Trauma ◽  
Spine Injury ◽  
Team Approach ◽  
Optimal Management ◽  
Imaging Studies ◽  
Cervical Injury ◽  
Cervical Spine Injuries ◽  
Spine Injuries

Cervical spine injury is relatively rare, occurring in only 2% to 3% of patients with blunt traumawho undergo imaging studies. However, timely and accurate recognition of cervical spine injuryis essential for the optimal management of patients with blunt trauma as subsequent morbidity includesprolonged immobilization. Evaluation of cervical spine injuries should begin in the emergencydepartment and involves a combination of pediatric, trauma, orthopedic, and neurosurgeons fordefinitive management. Knowing which patients are at highest risk for injuries will undoubtedlyinfluence decisions on how aggressively to pursue a potential cervical spine injury and can be achievedby establishing a multidisciplinary team approach that provides cervical spine immobilization,assessment, and clearance. Implementation of such guidelines will decrease time for cervical spineclearance and incidence of missed injuries. In this article different aspects of cervical spine injuriesand cervical spine clearance protocols are reviewed.Key words: cervical, injury, trauma, spine, vertebrae

scholarly journals Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

CJEM ◽  
2014 ◽  
Vol 16 (02) ◽  
pp. 131-135 ◽  
Author(s):  
Hendrik P. Van Zyl ◽  
James Bilbey ◽  
Alan Vukusic ◽  
Todd Ring ◽  
Jennifer Oakes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Clinical Skills ◽  
Ct Scans ◽  
Spine Injury ◽  
Emergency Physicians ◽  
Cervical Spine Injuries ◽  
Spine Ct ◽  
Spine Injuries ◽  
Rule Out

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

Neck Injury

1995 ◽  
Vol 16 (1) ◽  
pp. 28-28
Author(s):  
Jeffrey R. Avner
Keyword(s):  
At Risk ◽  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Pediatric Patients ◽  
Neck Injury ◽  
Spine Injury ◽  
Clinical Markers ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Spine Radiographs

Although rare in pediatrics, cervical spine injuries still are associated with serious morbidity, disability, and mortality. Many of these injuries are exacerbated by inadequate neck immobilization or improper manipulation. Thus, the physician should be aware of which children are at risk for cervical spine injury and how to assess these patients properly. To find clinical markers that identify children who actually have cervical spine injuries, Rachesky et al reviewed 2133 cervical spine radiographs obtained in pediatric patients during a 7-year period. Of these children, 25 (1.2%) had abnormalities confirmed on radiographs. The incidence of injury increased with age; only four of the children who had cervical spine injuries were less than 8 years old.

Detection of Cervical Spine Injuries in Alert, Asymptomatic Geriatric Blunt Trauma Patients: Who Benefits from Radiologic Imaging?

2006 ◽  
Vol 72 (9) ◽  
pp. 773-777 ◽  
Author(s):  
Adrian W. Ong ◽  
Aurelio Rodriguez ◽  
Robert Kelly ◽  
Vicente Cortes ◽  
Jack Protetch ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Spine ◽  
Blunt Trauma ◽  
Cervical Spine Injury ◽  
Motor Vehicle ◽  
Spine Injury ◽  
Trauma Patients ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Anatomic Locations

There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. We conducted a retrospective study of blunt trauma patients 65 years and older who were alert, asymptomatic, hemodynamically stable, and had normal neurologic examinations. For inclusion, patients were required to have undergone computed tomography and plain radiographs. The presence and anatomic location of potentially distracting injuries or pain were recorded. Two hundred seventy-four patients were included, with a mean age of 76 ± 10 years. The main mechanisms of injury were falls (51%) and motor vehicle crashes (41%). Nine of 274 (3%) patients had cervical spine injuries. The presence of potentially distracting injuries above the clavicles was associated with cervical injury when compared with patients with distracting injuries in other anatomic locations or no distracting injuries (8/115 vs 1/159, P = 0.03). There was no association of cervical spine injury with age greater or less than 75 years or with mechanism of injury. The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.

scholarly journals Fracture Heat Map of The Facial Skull Demonstrates a Danger Zone of Concomitant Cervical Spine Injuries

2020 ◽  
Author(s):  
Ákos Bicsák ◽  
Robert Sarge ◽  
Oliver Müller ◽  
Stefan Hassfeld ◽  
Lars Bonitz
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Maxillofacial Trauma ◽  
Spine Injury ◽  
Trauma Patients ◽  
Maxillofacial Injury ◽  
Cervical Spine Injuries ◽  
Spine Injuries

Abstract Concomitant maxillofacial and cervical spine injuries occur in 0.8%-12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture.A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization.7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1% and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.

scholarly journals Fracture heat map of the facial skull demonstrates a danger zone of concomitant cervical spine injuries

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ákos Bicsák ◽  
Robert Sarge ◽  
Oliver Müller ◽  
Stefan Hassfeld ◽  
Lars Bonitz
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Maxillofacial Trauma ◽  
Spine Injury ◽  
Trauma Patients ◽  
Maxillofacial Injury ◽  
Cervical Spine Injuries ◽  
Spine Injuries

AbstractConcomitant maxillofacial and cervical spine injuries occur in 0.8–12% of the cases. We examined the relation of injury localization and the probability of cervical spine fracture. A retrospective study was conducted on patients that have been treated at Dortmund General Hospital for injuries both to the maxillofacial region and to the cervical spine between January 1st, 2007 and December 31th, 2017. Descriptive statistical methods were used to describe the correlation of cervical spine injuries with gender, age as well as maxillofacial injury localization. 7708 patients were hospitalized with maxillofacial injury, among them 173 were identified with cervical spine injury. The average ages for both genders lie remarkably above the average of all maxillofacial trauma patients (36.2 y.o. in male and 50.9 y.o. in female). In the group of men, most injuries were found between the ages of 50 and 65. Whereas most injuries among women occurred after the age of 80. The relative ratio of cervical spine injuries (CSI) varies between 1.1 and 5.26% of the maxillofacial injuries (MFI), being highest in the soft tissue injury group, patients with forehead fractures (3.12%) and patients with panfacial fractures (2.52%). Further, nasal, Le Fort I and II, zygomatic complex and mandibular condyle fractures are often associated with CSI. Fractures next to the Frankfurt horizontal plane represent 87.7% of all MFI with concomitant CSI. Patients in critical age groups with a high-energy injury are more likely to suffer both, MFI and CSI injuries. Our findings help to avoid missing the diagnosis of cervical spine injury in maxillofacial trauma patients.

LITIGATION OF MISSED CERVICAL SPINE INJURIES IN PATIENTS PRESENTING WITH BLUNT TRAUMATIC INJURY

Neurosurgery ◽  
2007 ◽  
Vol 60 (3) ◽  
pp. 516-523 ◽  
Author(s):  
Gregory P. Lekovic ◽  
Timothy R. Harrington
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Traumatic Injury ◽  
Delayed Diagnosis ◽  
Spine Injury ◽  
Type I ◽  
Type Ii ◽  
Cervical Injury ◽  
Cervical Spine Injuries ◽  
Delays In Diagnosis

Abstract BACKGROUND Approximately 800,000 cervical spines are cleared in emergency departments each year. Errors in diagnosis of cervical spine injury are a potentially huge medicolegal liability, but no established protocol for clearance of the cervical spine is known to reduce errors or delays in diagnosis. METHODS The Lexis-Nexis, Westlaw, and Medline databases were queried for cases of missed cervical injury. Errors were categorized according to a novel system of classification. Type I errors occurred when inadequate or improper tests were ordered. Type II errors occurred when adequate tests were ordered, but were either misread or not read. Type III errors occurred when adequate tests were ordered and read accurately, but the ordered test was not sensitive enough to detect the injury. RESULTS Twenty cases of missed or delayed diagnosis of cervical spine injury were found in 10 jurisdictions. Awards averaged $2.9 million (inflation adjusted to 2002 dollars). Eight cases resulted in verdicts in favor of the defendant, but none of these cases involved an alleged Type II error. CONCLUSION Fear of lawsuits encourages defensive medicine and complicates the process of clearing a patient's cervical spine. This analysis adds medicolegal support for the judicious use of imaging studies in current cervical spine clearance protocols. However, exposure to significant liability suggests that a low threshold for computed tomography is a reasonable alternative.

Subaxial cervical spine injuries

2011 ◽  
Author(s):  
Sergio Mendoza-Lattes ◽  
Charles R. Clark
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Surgical Decompression ◽  
Group Classification ◽  
Spine Injury ◽  
Study Group ◽  
Cervical Spine Injuries ◽  
Subaxial Cervical Spine ◽  
Spine Injuries ◽  
Conscious Patient

♦ The spine study group classification describes three families of fractures♦ Clinical examination can exclude a cervical spine injury in a non-distracted conscious patient without pain and neurological deficit♦ CT scan is the investigation of choice where fracture is suspected♦ Pure ligamentous injuries are rare♦ Priorities are immobilization and assessment, reduction of dislocations and then surgical decompression and stabilization.

scholarly journals National Athletic Trainers' Association Position Statement: Acute Management of the Cervical Spine–Injured Athlete

2009 ◽  
Vol 44 (3) ◽  
pp. 306-331 ◽  
Author(s):  
Erik E. Swartz ◽  
Barry P. Boden ◽  
Ronald W. Courson ◽  
Laura C. Decoster ◽  
Mary Beth Horodyski ◽  
...  
Keyword(s):  
Health Care ◽  
Cervical Spine ◽  
Health Care Providers ◽  
Cervical Spine Injury ◽  
Athletic Trainers ◽  
Current Evidence ◽  
Spine Injury ◽  
Care Providers ◽  
Cervical Spine Injuries ◽  
Spine Injuries

Abstract Objective: To provide certified athletic trainers, team physicians, emergency responders, and other health care professionals with recommendations on how to best manage a catastrophic cervical spine injury in the athlete. Background: The relative incidence of catastrophic cervical spine injury in sports is low compared with other injuries. However, cervical spine injuries necessitate delicate and precise management, often involving the combined efforts of a variety of health care providers. The outcome of a catastrophic cervical spine injury depends on the efficiency of this management process and the timeliness of transfer to a controlled environment for diagnosis and treatment. Recommendations: Recommendations are based on current evidence pertaining to prevention strategies to reduce the incidence of cervical spine injuries in sport; emergency planning and preparation to increase management efficiency; maintaining or creating neutral alignment in the cervical spine; accessing and maintaining the airway; stabilizing and transferring the athlete with a suspected cervical spine injury; managing the athlete participating in an equipment-laden sport, such as football, hockey, or lacrosse; and considerations in the emergency department.

scholarly journals LOWER CERVICAL SPINE INJURY: DIAGNOSIS, CLASSIFICATION, TREATMENT

2005 ◽  
pp. 008-024
Author(s):  
Edvard Aleksandrovich Ramikh
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Medical Rehabilitation ◽  
Spine Injury ◽  
Lower Cervical Spine ◽  
Cervical Spine Injuries ◽  
Subaxial Cervical Spine ◽  
Spine Injuries ◽  
Modern Classification ◽  
Conservative And Surgical Treatment

During recent decades the spine specialists’ views on mechanism and nature of various injuries of the subaxial cervical spine have changed and become fuller. This predetermined the choice of pathogenetical therapy for each type of injury. In this respect the concept of treatment regimen for cervical spine injuries is presented from long-term experience of Trauma Clinics of Novosibirsk RITO and newer literature data. The problems of clinical semeiology, radiodiagnosis, lower cervical spine injury classifications are discussed. Issues of conservative and surgical treatment choice, medical rehabilitation of all types of subaxial cervical spine injuries in accordance with modern classification are considered in detail.

Halo vest versus spinal fusion for cervical injury: evidence from an outcome study

1989 ◽  
Vol 70 (6) ◽  
pp. 884-892 ◽  
Author(s):  
Richard D. Bucholz ◽  
K. Charles Cheung
Keyword(s):  
Cervical Spine ◽  
Medical Center ◽  
Spine Injury ◽  
Cervical Injury ◽  
Halo Vest ◽  
Content Type ◽  
Cervical Spine Injuries ◽  
Surgical Fusion ◽  
Spine Injuries ◽  
Halo Device

✓ The indications for surgical fusion, as opposed to halo fixation, in the management of cervical spine injury are still unclear. At St. Louis University Medical Center a conservative protocol has been adopted to treat almost all cervical spine fractures with halo fixation. To determine what factors have contributed to failure of halo fixation, the records and radiographs of all patients with cervical spine injuries who were treated at that institution between 1984 and 1986 were reviewed. During this interval, 124 patients were treated, consisting of 93 men and 31 women between 6 and 94 years old. Of these, 15 (12%) had cervical fusion without preoperative halo device application. This group included eight patients with old injuries and delayed diagnosis, three with nonreducible locked facets, and four with miscellaneous indications. The remaining 109 patients were treated with halo vests. Four died before completing the 3-month standard treatment. Of those completing the treatment, 48 had C1–2 level injuries and 57 had C3–T1 level injuries. Sixteen patients (15%) failed their halo treatments and required surgical fusion: eight while still in halo fixation and eight after they had completed treatment with a halo device. Failure of halo treatment was indicated by recurrent dislocation in 13 patients and increased neurological deficit in three. Thirteen of the patients who failed treatment had C3–T1 injuries and three had C1–2 injuries. Of 27 patients with odontoid fractures, only two (7.4%) failed halo fixation. There were no failures in 11 patients with hangman's fractures. Of the 57 patients with C3–T1 injuries, 13 (23%) failed treatment, nine of whom had locked or “perched” facets. The factors causing failure of halo fixation were analyzed. The overall success rate was 85%, suggesting that the halo vest can be used to treat most patients with cervical spine injuries. Under certain circumstances (in the presence of old injuries, difficult reduction, or locked or “perched” facets), surgery may be indicated to avoid unnecessary delay in definitive management.

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