Clinical presentation of patients with acute cervical spine injury

Walter, James J.; Doris, Peter E.; Shaffer, Mark A.

doi:10.1016/s0196-0644(84)80515-6

Cited by 72 publications

(9 citation statements)

References 15 publications

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“…Particularly, 58.7% of all vertebral fractures found on X-rays occurred in the thoracolumbar region (T11-L2), similar to previous stud- ies on patients with traumatic vertebral fractures [18,19]. In the cervical region, C2 was most frequently found in X-rays, and in MRI, C2 and C6 were identically commonly found, also like previous studies [20][21][22]. In case of the lumbar region, the number of fractures was the largest in L1, and was decreased as it was close to the sacral region.…”

Section: Discussionsupporting

confidence: 87%

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures

Lee

Jang

Kim

et al. 2017

Journal of Trauma and Injury

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Purpose: The purpose of this study was to evaluate the diagnostic accuracy of X-rays in patients with acute traumatic vertebral fractures visiting the emergency department and to analyze the diagnostic value of X-rays for each spine level. Methods: We retrospectively analyzed basal characteristics by reviewing medical records of 363 patients with adult traumatic vertebral fractures, admitted to the emergency center from March 1, 2014 to February 28, 2017. We analyzed spine X-rays and magnetic resonance imaging (MRI) scans to determine distribution according to the vertebral level, and we evaluated the efficacy of X-rays by comparing discrepancies between X-rays and MRI scans. Results: For a total of 363 patients, the mean age was 56.65 (20-93) and 214 (59%) were males. On the basis of X-rays, 67 cases (15.1%) were of the cervical spine, 133 cases (30.0%) were of the thoracic spine, and 243 cases (54.9%) were of the lumbar spine. In particular, the thoracolumbar region (T11-L2) was the most common, with 260 cases (58.7%). In X-rays, fractures were the least in the upper thoracic region (T1-T3), whereas MRI scans revealed fairly uniform distribution across the thoracic spine. Sensitivity of X-rays was lowest in the upper thoracic spine and specificity was almost always greater than 98%, except for 94.7% in L1. Positive predictive value was lower in the mid-thoracic region (T4-T9) and negative predictive value was slightly lower in C6, T2, and T3 than at other sites. Diagnostic accuracy of X-rays by vertebral body, transverse process, and spinous process according to fractured vertebral structures was significantly different according to vertebral level. Conclusions: Diagnostic accuracy of X-rays was lower in the upper thoracic region than in other parts. Further studies are needed to identify better methods for diagnosis considering cost and neurological prognosis.

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Section: Discussionsupporting

confidence: 87%

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures

Lee

Jang

Kim

et al. 2017

Journal of Trauma and Injury

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“…Although altered mental status, GCS <14, neurologic deficit or neck tenderness in the setting of trauma may raise the suspicion of cervical spine injury, a concern for occult injury [27]makes radiographic studies mandatory in these patients [28, 29, 30, 31]. Controversy exists as to the most appropriate radiographic workup for these patients.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spine Evaluation in Obtunded or Comatose Pediatric Trauma Patients: A Pilot Study

et al. 1999

Pediatr Neurosurg

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A uniformly accepted protocol for evaluation and clearance of the cervical spine of pediatric trauma patients with altered mental status does not currently exist. We sought to detect cervical spine injuries in this group with minimal risk. Patients were evaluated with standard three-view cervical spine radiographs and CT when necessary. Those patients without radiographic abnormality and altered mental status underwent flexion-extension of the cervical spine using fluoroscopy with somatosensory evoked potential (SSEP) monitoring. Those with abnormal movement by fluoroscopy or changes in SSEP underwent MRI. Fifteen patients were evaluated with this protocol. Two patients had movement on flexion-extension of the cervical spine and 5 had SSEP changes. Three patients had an MRI with only 1 showing injury. Five patients had residual hemiparesis. Evaluation of the cervical spine in obtunded or comatose pediatric trauma patients can be done safely with flexion-extension under fluoroscopy and SSEP monitoring. Further prospective studies are required to determine the efficacy of SSEP monitoring for cervical spine clearance in this select population.

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“…Patients who suffer a cervical spine injury (CSI) present to the Emergency Department (ED) in a variety of ways, ranging from complete quadriplegia to neurologically intact (1,2). The majority of CSI patients are transported to the ED in full spinal immobilization by Emergency Medical Services (EMS) providers, though many systems use selective immobilization protocols in the prehospital setting (3–6).…”

Section: Introductionmentioning

confidence: 99%

“…CSI epidemiology studies have identified at-risk groups based on age, gender, race, and most common mechanisms of injury (8,9). To our knowledge, no previous studies have focused specifically on the incidence and pattern of injury of patients arriving at an ED by private vehicle (PV).…”

Section: Introductionmentioning

confidence: 99%

Cervical Spine Injury: Analysis and Comparison of Patients by Mode of Transportation

Urdaneta¹,

Stroh²,

Teng³

et al. 2013

The Journal of Emergency Medicine

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Background Cervical spine injury (CSI) studies have identified different factors contributing to CSI, but none compares the incidence and pattern of injury of patients arriving at the Emergency Department (ED) by private vehicle (PV). Objective We compared the characteristics and injury patterns in CSI patients who were transported to the ED via Emergency Medical Services (EMS) versus PV. Methods We conducted a three-hospital retrospective review of patients with CSI from January 1, 2000 to December 31, 2007. We excluded transfers and followup visits. Using a standardized data collection form, we reviewed demographics, mode of transport, mechanism of injury, imaging results, injury type and level, and neurologic deficits. Means and proportions were compared using t-tests and chi-squared as appropriate. Results Of 1174 charts identified, 718 met all study criteria; 671 arrived by EMS and 47 by PV. There was no difference between groups in age or gender. Ground-level fall was more likely in PV patients (32%, 95% confidence interval [CI] 20–46% vs. 6%, 95% CI 4–9%), whereas motor vehicle collision was less likely (32%, 95% CI 20–46% vs. 67%, 95% CI 63–70%). PV patients more often sustained a stable injury (66%, 95% CI 52–78% vs. 40%, 95% CI 36–44%), and were more often triaged to a lower-acuity area (25%, 95% CI 15–40% vs. 4%, 95% CI 3–6%). The incidence of neurologic deficit was similar (32%, 95% CI 20–46% vs. 24%, 95% CI 21–28%), though more PV patients had spinal cord injury without radiographic abnormality (21%, 95% CI 12–35% vs. 5%, 95% CI 4–7%). Conclusion A small proportion of patients with CSI present to the ED by PV. Although most had stable injuries, a surprising number had unstable injuries with neurologic deficits, and were triaged to lower-acuity areas in the ED.

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Clinical presentation of patients with acute cervical spine injury

Cited by 72 publications

References 15 publications

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures

The Value of X-ray Compared with Magnetic Resonance Imaging in the Diagnosis of Traumatic Vertebral Fractures

Cervical Spine Evaluation in Obtunded or Comatose Pediatric Trauma Patients: A Pilot Study

Cervical Spine Injury: Analysis and Comparison of Patients by Mode of Transportation

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