Injuries of the cervical spine (original) (raw)
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Cervical Spine Injuries and Management: Experience with 235 Patients in 10 Years
min - Minimally Invasive Neurosurgery, 1999
During the past lO-year period 235 patients with ceıvical injury were inç|uded ln tİıis study, ln İh;s pape, we present our clinical experiences in patients with cervical spine injury treated surgically and conservatively and their outcome. Only few data exist on the treatment of cervical spine injuries-The principles of the management are still controversial. The 235 patients with cervicaİspine injury admitted to our department were as,essed with Frankel's grading scale and treated.surgically and İonservatlvely according to the type and leveJ of İl," lnjr.v; 172 patlents were treated surgically., and 63 patient § were managed conservatively. The neurological state of the patients and the treatment modality are summarized in ln the upper cervicai injury, except type ıı oJontoid fracture with a dislocation of more than 6 **, .onru*ative treatment modalities were performed, ln the iower cervical injury, an anterior approach with discecto-v "na anterior fusion were performed if there was spinal İoİd comp."srion anteriorly. Otheı-wise a posterior apjroach wlth decomp.ession and a varlety of posterior fuslon technlqru, *uru ,r"d.
Cervical spinal injury: experience with 82 cases
International Congress Series, 2002
A retrospective study of 82 cases of cervical spinal injury was made. These patients were treated in Dhaka Medical College Hospital, Mitford Hospital, Dhaka, and in some private hospitals in Dhaka City during the last 10 years from January 1991 to December 2000. Sixty-eight patients (82.92%) were between 21 and 50 years of age. Male and female ratio was almost 6:1. The most common cause of cervical spinal injury was a fall (53.65%), which was followed by road traffic accident (24.39%). The most common presenting symptoms and signs were: pain in the neck in all cases, quadriplegia/quadriparesis in 56 (68.29%), temporary loss of consciousness in 20 (24.39%) and sphincter disturbances in 48 (58.53%) patients. Twenty-six (31.70%) cases were free from neurological deficit. Plain X-ray cervical spine was done in all cases. Radiological evidence was found of cervical spinal injury in all but six cases (7.31%). Cervical myelogram was done in 12 (14.63%) cases and MRI of the cervical spine was done in 24 (29.27%) patients. Commonly affected sites of cervical spinal injury were found at C4/C5 and C5/C6 levels (43.92%). Forty-three (52.45%) cases were treated conservatively by Tong Skull traction and immobilization, and 39 (47.55%) were operated upon. Anterior fusion was done in 25 cases (30.49%) and posterior fusion in 10 (12.19%). Results of treatment were: full recovery in 30 patients (36.57%), good recovery in 16 (19.52%), partial recovery in 26 (31.71%) and no change in neurological state in 6 (7.32%). Recurrence of dislocation and consequent neural compression was found in six (7.32%) cases of the conservative treatment group of patients. Mortality was three (3.66%), also in the nonoperative group of patients. It was seen that there were better treatment results in cases of surgical fusion in unstable cervical injury, and there was a chance of instability and delayed loss of neurological function in conservative treatment of unstable cervical spinal injury, which needed subsequent surgical fusion.
The Management of Cervical Spine Injuries – A Literature Review
Orthopedic Research and Reviews, 2021
Due to the inherent bony instability of the cervical spine, there is an over-reliance on ligamentous structures for stability, making this segment of the vertebral column most prone to traumatic injuries. The frequently occurring mechanisms of injury include axial compression, hyper-flexion, hyper-extension, and rotational type injuries. Good pre-hospital care and a thorough assessment in the emergency department of patients suspected to have a cervical spine injury (CSI) leads to improved clinical outcomes. The objective of the initial evaluation of a patient with a suspected CSI is to identify the presence of injuries through thorough clinical and radiologic assessments as missed injuries are potentially catastrophic. The treatment of cervical spine injuries can be conservative, pharmacological, or surgical, and aims to halt SCI progression, stabilize the spine, and to allow rehabilitation of the patient.
Upper cervical spine injuries: a management of a series of 70 cases
The Pan African medical journal, 2013
Traumatic injuries of the upper cervical spine are often encountered, and may be associated to severe neurological outcome. This is a retrospective study of 70 patients, admitted over a 14 years period (1996 to 2010), for management of upper cervical spine injuries. Data concerning epidemiology, radiopathology and treatment was reviewed, and clinical and radiological evaluation was conducted. Men are more affected than women, with traffic accidents being the major traumatic cause. A cervical spine syndrome of varied intensity was found in about 90% of patients; neurological deficit was noted in 10 patients (21%). Radiological analysis discovered varied and many combined lesions: C1-C2 dislocation (7 cases), C2-C3 dislocation (9 cases), C1 fracture (10 cases) and C2 fracture (44 cases) including 28 odontoid fractures. Orthopedic treatment was carried out exclusively for 31 patients, and surgical treatment for 38 patients. One patient died before surgery because of a polytraumatisme. ...
Fractures of the cervical spine
Clinics, 2013
The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. 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 Professional Medical Journal, 2015
Objectives: To measure outcome of patients with cervical spine injury treatedwith and without surgical intervention. Study Design: Cross sectional study. Place andDuration of Study: 3years, Department of neurosurgery, Nishtar hospital Multan. Patients andMethods: Total 43 patients with cervical spine injury fulfilling the inclusion and exclusion criteriawere admitted from OPD and emergency department of Nishtar Hospital Multan. Patients wereexamined for motor loss at the time of admission and on follow after the assigned treatment.MRI neck was performed in all patients. Results: There were 43 patients in total. Males were31 (72%) while females were 13 (28%) with 2.5:1 ratio. Mean age was 33.92 ± 11.4. MeanPower grade was 2.2± 1.4 at the time of admission while on follow mean Grade of power was3.34±1.51 with P value of 0.00. Conclusion: Cervical spine injury patients are associated withImprovement in power with or without surgical intervention.
Injuries of the upper cervical spine: A series of 28 cases
Indian Journal of Orthopaedics, 2007
Background: There are very few published reports of upper cervical spine injuries from our country and there is a heavy bias towards operative treatment of these injuries. We present below our experience of upper cervical injuries over the last four years. Materials and Methods: Twenty eight patients (20 males, 8 females) with upper cervical spine injury (including Occiput, Atlas and Axis) were treated and were followed-up for an average of 11.2 months. The data was analyzed retrospectively with regards to the location and type of injury, the treatment offered (conservative or operative) as well as the fi nal clinical and radiological outcome. Results: The clinico-radiological outcome of treatment of these injuries is mostly very good with few complications. Other than a single case of mortality due to associated head injury there were no major complications. Conclusion: Management of these patients needs a proper evaluation to arrive at the type of injury and prompt conservative or operative treatment. Treatment is usually safe and effective with good clinical and radiological outcome.
During the past lO-year period 235 patients with ceıvical injury were inç|uded ln tİıis study, ln İh;s pape, we present our clinical experiences in patients with cervical spine injury treated surgically and conservatively and their outcome. Only few data exist on the treatment of cervical spine injuries-The principles of the management are still controversial. The 235 patients with cervicaİspine injury admitted to our department were as,essed with Frankel's grading scale and treated.surgically and İonservatlvely according to the type and leveJ of İl," lnjr.v; 172 patlents were treated surgically., and 63 patient § were managed conservatively. The neurological state of the patients and the treatment modality are summarized in ln the upper cervicai injury, except type ıı oJontoid fracture with a dislocation of more than 6 **, .onru*ative treatment modalities were performed, ln the iower cervical injury, an anterior approach with discecto-v "na anterior fusion were performed if there was spinal İoİd comp."srion anteriorly. Otheı-wise a posterior apjroach wlth decomp.ession and a varlety of posterior fuslon technlqru, *uru ,r"d.
Surgical treatment of cervical spine trauma: Our experience and results
OBJECTIVE AND BACKGROUND: The objective of this study is to evaluate how the neurological outcome in patients operated for cervical spinal cord injury (SCI) is influenced by surgical timing, admission American Spinal Injury Association (ASIA) grading system, and age. MATERIALS AND METHODS: From January 2004 to December 2011, we operated 110 patients with cervical SCI. Fifty-seven of them (44 males and 13 females) with preoperative neurological deficit, were included in this study with a complete follow-up. Age, sex, associated comorbidities (evaluated with Charlson comorbidity index [CCI]), mechanism of trauma, preoperative and follow-up ASIA score, time elapsed from injury to surgical treatment, preoperative cervical computed tomography scan or magnetic resonance imaging, type of fractures, and surgical procedure were evaluated for each patient. The patient population was divided into two groups related to the timing of surgery: Ultra-early surgery group (within 12 h from the trauma, 27 patients) and early surgery (within 12-72 h from the trauma, 30 patients). STATISTICAL ANALYSIS USED: The univariate analysis of data was carried out by the Chi-square test for discrete variables, the t-test for the continuous ones. Logistic regression was used for the multivariate analysis. RESULTS: Neurological outcome was statistically better in ultra-early surgery group (<12 h) than in patient underwent surgery within 12-72 h (82.14% vs. 31%, multivariate analysis P = 0.005). The neurological improvement was also correlated with the age and the ASIA grade at admission in the univariate analysis (P = 0.006 and P = 0.017 respectively) and in the multivariate 1 (P = 0.037 and P = 0.006 respectively) while the CCI was correlated with the improvement only in the univariate analysis (P = 0.007). CONCLUSION: Nowadays, in patients with cervical SCI early surgery could be associated with improved outcome, most in case of young people with mild neurological impairment. KEYWORDS: Spinal cord injury; spine trauma; surgical decompression; timing of operation; traumatic cervical spinal cord injury