Unstable cervical spine without spinal cord injury in penetrating neck trauma

Apfelbaum, Jonathan D.; Cantrill, Stephen V.; Waldman, Neil

doi:10.1016/s0735-6757(00)90049-4

Cited by 20 publications

(8 citation statements)

References 14 publications

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“…12 This is despite reports in literature that emphasizes the need to address life threatening injuries before the concern for immobilizing the neck as instability from the initial missile injury is rare. [13][14][15][16] For example, in patients with isolated GSW to the head, although there are reports that immobilization and diagnostic radiography is of minimal use, [17][18][19] Kaups et al, demonstrated that airway management was compromised by cervical immobilization as more intubation attempts occurred with cervical spine immobilization than without. 20 The emphasis of the mechanism of injury and its association with cervical spinal injuries would also be beneficial to the military where penetrating injury is the predominant mechanism.…”

Section: Discussionmentioning

confidence: 99%

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Rhee

Kuncir

Johnson

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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Section: Discussionmentioning

confidence: 99%

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Rhee

Kuncir

Johnson

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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“…study was predictable from the surveyed literature and may reflect an incidence so remote as to be undiscoverable. Only one case of cervical spine instability resulting from penetrating cervical trauma in a neurologically intact patient has been reported and the accuracy of this report has been challenged (Vanderlan) [20]. Interestingly, the patient's cervical collar was removed in transit for control of hemorrhage without resultant central neurologic injury [20].…”

Section: Discussionmentioning

confidence: 98%

“…Only one case of cervical spine instability resulting from penetrating cervical trauma in a neurologically intact patient has been reported and the accuracy of this report has been challenged (Vanderlan) [20]. Interestingly, the patient's cervical collar was removed in transit for control of hemorrhage without resultant central neurologic injury [20]. With only a single case report of a neurologically intact patient with cervical spine instability secondary to penetrating cervical trauma, the true number needed to treat (NNT) was hypothesized to lie between zero and negative infinity (0>NNT>-∞).…”

Section: Discussionmentioning

confidence: 99%

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Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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This study hypothesized that cervical spine immobilization (CSI) in penetrating cervical trauma is associated with increased central neurologic injury rather than prevention. Data abstraction proceeded from a previously constructed patient database formed via retrospective chart analysis of the trauma registries of two independent American College of Surgeons verified Level 1 Trauma centers. Neurologic injuries were categorized as peripheral or central. Central neurologic injuries were further subdivided into spinal cord and brain injuries. Patients were grouped according to the presence and type of neurologic injury, the presence and type of cervical spine fracture, death, and the presence or absence of respiratory and vascular injury. Vascular injury was further subdivided into major and minor categories. Groups were compared statistically. Significance was accepted for p<0.05. Cervical spine fracture (CSFx) was a significant risk factor for cervical spinal cord injury (CSCI) (p<0.00001; RR 20.56; 95% CI 8.44-26.47) but all patients with unstable CSFx presented with complete spinal neurologic devastation. Major vascular injury was associated with brain injury (p=0.01; RR 10.21; 95% CI 6.67-15.65) but was not associated with CSCI (p=0.99) or CSFx (p=0.67). Hypoperfusion was a strong independent risk cervical cord and brain injury (p<0.00001; RR 38.4; 95% CI 16.17-91.2). CSI was a significant risk factor for indirect central neurologic injury (p<0.001; RR 1.63; 95% CI 1.23-1.95). Brain injury was not associated with CSFx (p=0.35) or CSCI (p=0.08). No benefit of CSI in penetrating cervical trauma could be determined from this study. CSI entailed an absolute risk increase for central neurologic injury of 18.69% with a 5.3 number needed to harm (NNH).

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“…The overall rate of delayed or missed diagnosis ranges from 0.01% to 26%, but is generally believed to be 5%-20% of all cases. [13][14][15][16][17][18][19] The incidence of cervicothoracic junction trauma has been reported ranging from 2.4% to 50% of all cervical spine fractures. 5,9,18 Detection of injuries in this location is very important because of a very high risk of neurological deficit due to spinal cord injury, reportedly as high as 59%-78%.…”

Section: Incidence and Epidemiologymentioning

confidence: 99%

Imaging of cervicothoracic junction trauma

Wongwaisayawan¹,

Suwannanon²,

Kaewlai³

2013

RMI

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Cervicothoracic junction trauma is an important cause of morbidity and mortality in trauma patients. Imaging has played an important role in identifying injuries and guiding appropriate, timely therapy. Computed tomography is currently a method of choice for diagnosing cervicothoracic junction trauma, in which the pattern of injuries often suggests possible mechanisms and potential injuries. In this article, the authors describe and illustrate common and uncommon injuries that can occur in the cervicothoracic junction.

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Unstable cervical spine without spinal cord injury in penetrating neck trauma

Cited by 20 publications

References 14 publications

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Cervical Spine Injury is Highly Dependent on the Mechanism of Injury Following Blunt and Penetrating Assault

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Imaging of cervicothoracic junction trauma

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