Frequency and significance of fractures of the upper cervical spine detected by CT in patients with severe neck trauma.

Blacksin, Marcia F.; Lee, Huey Jen

doi:10.2214/ajr.165.5.7572503

Cited by 117 publications

(40 citation statements)

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“…In the present survey, some cases lacked complete information [7,18,21,28, 38, 39, 52] and were not included in appropriate parts of our analysis.…”

Section: Methodsmentioning

confidence: 99%

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Occipital condyle fractures: report of five cases and literature review

et al. 2005

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“…In the present survey, some cases lacked complete information [7,18,21,28, 38, 39, 52] and were not included in appropriate parts of our analysis.…”

Section: Methodsmentioning

confidence: 99%

“…For 20 patients, information was not provided about clinical condition on admission [7,18,21,28,38,39,52]. Fifty-five patients were awake on admission or had minor disturbances (54%); 46 patients had impaired consciousness (45%).…”

Section: Case History Of One Patientmentioning

confidence: 99%

Occipital condyle fractures: report of five cases and literature review

et al. 2005

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“…Kirschenbaum et al [127] described 7 ⁄ 53 (13.2%) patients suffering severe head injury with false negative craniocervical plain films but fractures apparent on CT. Similarly, routinely replacing the odontoid plain film with CT revealed upper cervical fractures in 8% of victims, and all survivors required halo stabilization [140]. Almost 9% of patients may have upper injuries revealed by CT alone [141], with 28.0-39.3% of C1 ⁄ C2 fractures missed by plain films [142,143].…”

Section: Computerised Tomographymentioning

confidence: 99%

“…Almost 9% of patients may have upper injuries revealed by CT alone [141], with 28.0-39.3% of C1 ⁄ C2 fractures missed by plain films [142,143]. It would therefore seem a minimum standard to perform directed craniocervical scanning in patients after head injuries, and certainly if a head or brain scan is being performed [127,[140][141][142][143].…”

Section: Computerised Tomographymentioning

confidence: 99%

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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“…In recent years digital imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) are increasingly replacing conventional radiographic applications as the gold standard for the assessment of the post-traumatized cervical spine [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Postmortem Multislice Computed Tomography and Magnetic Resonance Imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema

et al. 2005

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Non-invasive imaging methods are increasingly entering the field of forensic medicine. Facing the intricacies of classical neck dissection techniques, postmortem imaging might provide new diagnostic possibilities which could also improve forensic reconstruction. The aim of this study was to determine the value of postmortem neck imaging in comparison to forensic autopsy regarding the evaluation of the cause of death and the analysis of biomechanical aspects of neck trauma. For this purpose, 5 deceased persons (1 female and 4 male, mean age 49.8 years, range 20-80 years) who had suffered odontoid fractures or atlantoaxial distractions with or without medullary injuries, were studied using multislice computed tomography (MSCT), magnetic resonance imaging (MRI) and subsequent forensic autopsy. Evaluation of the findings was performed by radiologists, forensic pathologists and neuropathologists. The cause of death could be established radiologically in three of the five cases. MRI data were insufficient due to metal artefacts in one case, and in another, ascending medullary edema as the cause of delayed death was only detected by histological analysis. Regarding forensic reconstruction, the imaging methods were superior to autopsy neck exploration in all cases due to the post-processing possibilities of viewing the imaging data. In living patients who suffer medullary injury, follow-up MRI should be considered to exclude ascending medullary edema.

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Frequency and significance of fractures of the upper cervical spine detected by CT in patients with severe neck trauma.

Abstract: OBJECTIVE

Cited by 117 publications

References 0 publications

Occipital condyle fractures: report of five cases and literature review

Occipital condyle fractures: report of five cases and literature review

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

Postmortem Multislice Computed Tomography and Magnetic Resonance Imaging of odontoid fractures, atlantoaxial distractions and ascending medullary edema

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