Evaluation of the Cervical Spine in the Polytrauma Patient

Harris, Mitchel B.; Kronlage, Steven C.; Carboni, Phyllis A.; Robert, K.Q.; MenMuir, Brett; Ricciardi, James E.; Chutkan, Norman

doi:10.1097/00007632-200011150-00008

Cited by 71 publications

(48 citation statements)

References 19 publications

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“…In a recent UK survey of intensive care units, 48% of respondents were satisfied to clear the cervical spine while patients were unconscious and unable to provide clinical clues [115], and in published studies, 12-95% of clinicians have been confident in excluding injury with this view alone [12,98,116]. While the prevalence of this practice may vary, with a sensitivity of only 85% among an unconscious polytrauma population with a > 10% prevalence of cervical spine injury, missing at least 1.5% of injuries is unacceptable.…”

Section: Cervical Spine Imaging Modalitiesmentioning

confidence: 99%

“…Following normal baseline plain films or directed CT, published studies use varying combinations of axial stress, i.e. traction along the line of the cervical spine, to reveal joint space widening [116] and ⁄ or flexion ⁄ extension views. Dynamic fluoroscopy must be distinguished from static maximal flexion ⁄ extension views, which are inherently unsafe in the unconscious as the spine is not imaged during mobilization.…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

“…It is assumed that instability will be demonstrated under real time imaging, and the test can be terminated before significant cord injury occurs. While this may not be unreasonable, the procedure could potentially be made safer by performing a preceding axial 'stretch test' [116] or monitoring somatosensory evoked potentials [185]. Most studies use criteria for instability similar to those defined by White & Panjabi [186] of 3 mm displacement of adjacent vertebrae or > 11°of angulation, but this is by no means standard.…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

“…The worldwide literature reports 887 patients undergoing dynamic fluoroscopy in 10 separate studies [22,24,36,37,116,[187][188][189][190][191] (Table 1).…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

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Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

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SummaryCervical spine injury occurs in 5-10% of cases of blunt polytrauma. A missed or delayed diagnosis of cervical spine injury may be associated with permanent neurological sequelae. However, there is no consensus about the ideal evaluation and management of the potentially injured cervical spine and, despite the publication of numerous clinical guidelines, this issue remains controversial. In addition, many studies are limited in their application to the obtunded or unconscious trauma victim. This review will provide the clinician managing unconscious trauma victims with an assessment of the actual performance of clinical examination and imaging modalities in detecting cervical spine and isolated ligamentous injury, a review of existing guidelines in light of the available evidence, relative risk estimates and a proposed management scheme. Cervical spine and associated spinal cord injury significantly affect the individual's functional capacity and quality of life, and carry significant implications for society. It was estimated in 1988 that a 27-year-old rendered tetraparetic would consume US$ 1 million for lifetime care and, with 721 tetraparetic individuals per million of the population, the total aggregate costs were an estimated US$ 5.6 billion per year [1]. In America, cervical, thoracic and lumbar vertebral fractures occur with an incidence of 50 000 per year [2], and cervical spine injury has an annual incidence of 5-10 000 cases per year [3,4]. More recent estimates suggest an incidence of 8-10 000 spinal cord injuries per year, of which 55% are cervical [5]. In the UK, there are approximately 1000 new cases of cervical cord injury each year [6]. Cervical spine injury complicates blunt polytrauma in 2-12% of cases [7][8][9]. However, several larger reviews that include 29 000 blunt trauma victims, and additional prospectively gathered data, demonstrate a generally lower incidence (2.0-5.2%) [10][11][12][13].The presence of a severe head injury increases the relative risk of a cervical spine injury, possibly by 8.5 times, and a focal neurological deficit by 58 times [14]. A Glasgow Coma Scale (GCS) score of < 8 is associated with a 50% increase in the incidence of cervical spine injury to 7.8% [15]. Similarly, Demetriades et al.[16] have shown that although the incidence of cervical spine injury in trauma victims with a GCS score of 13-15 was only 1.4%; this increased to 10.2% if GCS was < 8. 'Primary' cervical spine injury may be associated with head injury in 24-35% of cases [10,[16][17][18][19][20], and among polytrauma victims requiring cervical spine stabilization surgery, only 74% suffered an isolated injury [21]. The prognosis in patients suffering both head and cervical injury is typically poor, with approximately 25% being discharged to a dedicated nursing facility with little prospect of recovery [22]. Traumatic brain injury has a UK incidence of 100 per 100 000 population [23], typically among young, working age males, and therefore the combined consequences of brain and spine injury both ...

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Section: Cervical Spine Imaging Modalitiesmentioning

confidence: 99%

Section: Dynamic Fluoroscopymentioning

confidence: 99%

Section: Dynamic Fluoroscopymentioning

confidence: 99%

“…The worldwide literature reports 887 patients undergoing dynamic fluoroscopy in 10 separate studies [22,24,36,37,116,[187][188][189][190][191] (Table 1).…”

Section: Dynamic Fluoroscopymentioning

confidence: 99%

See 2 more Smart Citations

Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening

Morris¹,

McCoy²

2004

Anaesthesia

106

View full text Add to dashboard Cite

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“…3 In addition, several authors cited the location of the separation and longitudinal studies document- ing the eventual posttraumatic development of OO in patients whose cervical spine radiographs were initially normal after the injury. [81][82][83] One of the examples is that of Schuler et al 82 report in 1991, which documented the development of OO after a significant period of trauma. This study reported the natural history of the abnormality observed in a 2-year-old girl who experienced neck pain after a significant fall.…”

Section: Introductionmentioning

confidence: 99%

Os Odontoideum: Review Article

Rahimizadeh¹

2017

Orthop Res Traumatol Open J

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Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the asymptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.

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