Unrecognized Spinal Instability Associated with Seemingly “Simple” Cervical Compression Fractures

Jm, Mazur; Es, Stauffer

doi:10.1097/00007632-198310000-00002

Cited by 36 publications

(5 citation statements)

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“…Close clinical follow-up is advocated in all injuries with potential instability, even if initial signs are absent. 20,23 Cervical subluxation or dislocation is often associated with neurologic deficits secondary to spinal cord com- pression. It is known that hastened relief of compression may lead to neurologic recovery.…”

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Cervical Ligamentous Instability Without Radiologic Evidence

Shah¹,

Marco²

2007

Spine

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This is a rare reported case of delayed presentation of an unstable ligamentous injury in a nondisplaced cervical pillar fracture without initial radiologic evidence of instability. If any reason to suspect ligamentous injury exists, workup with upright cervical lateral radiographs, flexion/extension radiographs, or magnetic resonance imaging should be obtained. Awake, closed reduction with cervical traction followed by surgical stabilization with an anterior discectomy and instrumented arthrodesis with structural autograft achieved stable fixation.

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Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Cervical Ligamentous Instability Without Radiologic Evidence

Shah¹,

Marco²

2007

Spine

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“…1 In addition to routine cervical radiographs, delayed flexion-extension radiographs after the muscle spasm is resolved for unmasking instability, 5 and computerized tomography or MRI for ruling out concurrent spinal pathologies and for assessing posterior thoracic elements 3 are also recommended in these patients. 1 In addition to routine cervical radiographs, delayed flexion-extension radiographs after the muscle spasm is resolved for unmasking instability, 5 and computerized tomography or MRI for ruling out concurrent spinal pathologies and for assessing posterior thoracic elements 3 are also recommended in these patients.…”

Section: Discussionmentioning

confidence: 99%

Peculiar Fracture of the Cervical Spine: A Rara Avis

Özçakar

Başgöze²

2003

Spine

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“…8 Performance of FECSR may need to be postponed even for weeks in patients with suspected ligamentous injury if cervical muscle spasm prevents adequate range of motion to assess stability. 10,15,21,30,32,42 In adults, performance of FECSR has been recommended at six to 12 weeks posttrauma in patients injured by a hyperflexion mechanism or with persistence of neck pain to rule out late instability. 23,24,43 Is FECSR safe in infants and young children who are unable to voice pain or neurological symptoms during flexion and extension maneuvers?…”

Section: Discussionmentioning

confidence: 99%

Role of Flexion—Extension Radiographs in Blunt Pediatric Cervical Spine Injury

Ralston

Chung

Barnes

et al. 2001

Academic Emergency Medicine

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Abstract. Objective: To determine whether flexion-extension cervical spine radiography (FECSR) is abnormal in children who have sustained blunt cervical spine injury (CSI) when standard cervical spine radiography (SCSR) demonstrates no acute abnormalities. Methods: This was a blinded radiographic review of 129 patients Յ16 years of age evaluated at an academic pediatric trauma center during July 1990-March 1996. All patients had SCSR (anteroposterior/lateral views) and FECSR performed for a trauma-related event within seven days of injury. Results: Of 46 patients without acute abnormalities on SCSR, one patient (with final clinical diagnosis of ''no CSI'') had acute abnormalities on FECSR (95% CI = 0.06% to 11.5%). Of 50 patients with isolated loss of lordosis on SCSR, no patient had acute abnormalities on FECSR (95% CI = 0% to 5.8%). The FECSR review revealed no acute abnormalities in 75 of 83 patients (90.4%) with suspicious findings for CSI viewed on SCSR (95% CI = 81.9% to 95.7%). Complications during FECSR were noted in one patient with transient paresthesias (0.8%) (95% CI = 0.02% to 4.2%). Conclusions: In children who underwent acute radiographic evaluation of blunt cervical spine trauma, FECSR was unlikely to be abnormal when no acute abnormality or isolated loss of lordosis was evident on SCSR. In a subset of patients with suspicious findings for occult CSI on SCSR, FECSR was useful in ruling out ligamentous instability in the acute, posttrauma setting. Key words: child; cervical spine; injury; radiographs; flexion; extension. ACADEMIC EMERGENCY MEDICINE 2001; 8:237-245 F LEXION-extension cervical spine radiography (FECSR) is used in the evaluation of blunt pediatric cervical spine injury (CSI) as an adjunct to standard three-view (i.e., anteroposterior, lateral, and open-mouth odontoid) cervical spine radiography (SCSR), but to the best of our knowledge, its role has not been systematically investigated.Traditional indications for FECSR in children include the evaluation of occult ligamentous injury in patients with suspicious SCSR, 1,2 abnormal physical examination findings despite normal SCSR, 1 and spinal cord injury without radiographic abnormality (SCIWORA).3,4 Flexion views in particular have been recommended in children with C1/C2 injuries to show transverse ligament rupture 2 and hyperflexion injuries to reveal occult posterior ligamentous complex instability. adjunct to SCSR in the acute plain radiographic evaluation of CSI in children who had sustained blunt cervical spine trauma. Our hypothesis was that FECSR is unlikely to be abnormal if SCSR demonstrates no acute abnormalities. METHODSStudy Design. We conducted a blinded radiographic review of SCSR and FECSR applied to a pediatric population. Pertinent clinical and radiographic information was obtained retrospectively. Institutional review board approval for the study was obtained with waiver of written informed consent.Study Setting and Population. Patients Յ16 years of age who underwent SCSR and FECSR for a trauma-related event within...

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Unrecognized Spinal Instability Associated with Seemingly “Simple” Cervical Compression Fractures

Cited by 36 publications

References 0 publications

Delayed Presentation of Cervical Ligamentous Instability Without Radiologic Evidence

Delayed Presentation of Cervical Ligamentous Instability Without Radiologic Evidence

Peculiar Fracture of the Cervical Spine: A Rara Avis

Role of Flexion—Extension Radiographs in Blunt Pediatric Cervical Spine Injury

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