Emergency Department Evaluation and Treatment of Cervical Spine Injuries

Kanwar, Rajdeep; Delasobera, B. Elizabeth; Hudson, Korin B.; Frohna, William J.

doi:10.1016/j.emc.2014.12.002

Cited by 27 publications

(17 citation statements)

References 55 publications

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“…The age of the included studies and the evolving management strategies for patients presenting with C‐spine injuries also limits the generalizability of this review to current practice. While the majority of studies assessed only simple radiography, CT scans have now become the image modality of choice in some locations . In addition, many residents and physicians now receive training on the use of CDRs and campaigns such as Choosing Wisely have worked to increase awareness of imaging overuse.…”

Section: Limitationsmentioning

confidence: 99%

Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

Desai

Liu

Kirkland

et al. 2018

Academic Emergency Medicine

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Section: Limitationsmentioning

confidence: 99%

Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

Desai

Liu

Kirkland

et al. 2018

Academic Emergency Medicine

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“…MRI prior to closed reduction is not indicated, unless the patient is unable to communicate neurological changes during the reduction process. [27] Neurological examination should be performed before and after any intervention and must be clearly documented. Rapid neurological decline may be due to ongoing compression or significant instability and may necessitate urgent open reduction.…”

Section: Recommendationsmentioning

confidence: 99%

Closed traction reduction of cervical spine facet dislocations: Compelled by law

Potgieter

Mohideen

et al. 2019

S Afr Med J

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The urgency of closed reduction of acute low-velocity cervical facet dislocations has recently been highlighted by the Constitutional Court of South Africa (SA), following a permanent spinal cord injury that a young rugby player sustained during a club-level match. The court found that if emergency care of the complainant had resulted in rapid closed reduction of his cervical spine injury, he might not have suffered permanent neurological damage. [1] The findings of the court were based on research by Newton et al., [2] who specifically looked at the timing of reduction of low-velocity cervical facet dislocation sustained by rugby players. In their cohort, reduction of facet dislocation within 4 hours after injury was associated with improved neurological outcomes. By performing an early closed reduction of the cervical spine, pressure is relieved from the spinal cord, preventing secondary ischaemic trauma and thus improving the possibility of neurological recovery. [3-5] It is important to note that this cohort of patients sustained low-velocity injuries. These may include sports-related injuries, falls from a standing height and blunt object assault. The severity of spinal cord trauma, or the viscous response of spinal cord tissue, is a product of the severity of compression, duration of compression and rate at which compression is applied, [6] which can also be referred to as the velocity of trauma. When compression is applied at a lower velocity, the spinal cord is more likely to show recovery and can withstand higher loads of compression than when subjected to the same compressive load applied at a higher velocity. Animal studies demonstrated this threshold to be 3 m/s, which equates to a fall from a standing height. [7] The current dispensation in SA demands that injuries of this nature be treated in specialised orthopaedic or neurosurgical units, or by qualified surgeons, with limited, if any, attempts at a closed reduction prior to arrival at a dedicated unit or service. The question of feasibility of mandatory closed reduction of cervical facet dislocations within 4 hours is therefore raised. This study reviews the time delays, delaying factors and success rate of closed reductions of cervical facet dislocations in an orthopaedic department at a tertiary-level training hospital over a period of 8 years. Methods A retrospective review of case notes and imaging screens of patients >18 years of age with cervical facet-joint dislocations presenting to a tertiary-level academic hospital in Western Cape Province of SA was performed. The university-affiliated hospital has a capacity of 1 899 beds and provides advanced trauma and This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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“…where 2 , 1 , and 0 are straightforwardly estimated. According to [55], if 2 1 − 4 3 0 ≥ 0 ( 0 = 2 2 − 3 1 , 1 = 2 3 2 − 9 1 2 + 27 0 ), then 2 can be explicitly calculated as…”

Section: Design Of the Reference Trajectories For The Patient'smentioning

confidence: 99%

“…Among the illnesses restricting the articulations movements, there are several sicknesses which may affect the mobility of the cervical vertebra. Vertebral herniated disk, radiculopathy, meningitis, and vertebral fractures are the most common pathologies associated with the cervical section of the spinal cord [3][4][5]. In general, their symptoms include persistent 2 Mathematical Problems in Engineering pain, controlled mobilization difficulties of the affected zone, and restricted articulation displacements as well as muscular inflammation [6].…”

Section: Introductionmentioning

confidence: 99%

Impedance Adaptive Controller for a Prototype of a Whiplash Syndrome Rehabilitation Device

Guzman-Victoria

Salgado

Mera

et al. 2019

Mathematical Problems in Engineering

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The objective of this study was to design of an output based impedance adaptive controller for a special class of cervical orthoses, a class of biomedical devices for the rehabilitation of neck illnesses. The controller used the adaptive sliding mode theory to enforce the tracking of the reference trajectory if the patient was not resistant to the therapy. If the patient rejects the orthosis activity, a second impedance-based controller governs the orthosis movement allowing the patient to take the leading role in the orthosis sequence of movements. The proposed controller considers a weighted controller combining the tracking and the impedance controls in a single structure. The monitoring of the external force was evaluated on a novel weighting function defining on-line the role of each controller. The proposed orthosis was motivated by the prevalence of whiplash, which is a syndrome that is produced by forced hyperextension and hyperflexion of the neck. This study included the development of a technological prototype of the orthotic type to support the recovery of patients diagnosed with whiplash. The sections that make up the orthotic device are two independent systems that move the patient’s head in the sagittal and frontal planes. For this purpose, the mechanical structure of the cervical orthosis was made up of 7 pieces printed in 3D with polylactic acid (PLA). The operation of the cervical orthosis was evaluated in two sections: (a) using a simulation system, which consists of a spring with an artificial head and the development of a graphic interface in Matlab, and (b) evaluating the controller on the proposed orthosis. With these elements, the follow-up of the trajectory proposed by the actuators was evaluated, as well as its performance in the face of the opposition that a patient generates. The superiority of the proposed controller was confirmed by comparing the tracking efficiency with proportional-integral-derivative and first-order sliding variants.

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Emergency Department Evaluation and Treatment of Cervical Spine Injuries

Cited by 27 publications

References 55 publications

Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

Effectiveness of Implementing Evidence‐based Interventions to Reduce C‐spine Image Ordering in the Emergency Department: A Systematic Review

Closed traction reduction of cervical spine facet dislocations: Compelled by law

Impedance Adaptive Controller for a Prototype of a Whiplash Syndrome Rehabilitation Device

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