Unsuspected upper cervical spine fractures associated with significant head trauma: Role of CT

Kirshenbaum, Kevin J.; Nadimpalli, S R; Fantus, Richard J; Cavallino, Robert P.

doi:10.1016/0736-4679(90)90230-s

Cited by 64 publications

(22 citation statements)

References 5 publications

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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].…”

Section: Computerised Tomographymentioning

confidence: 99%

“…Non-visualisation of the cervicothoracic junction on plain films may occur in up to 63% of cases [127,[132][133][134][135][136][137][138], typically requiring CT supplementation. Cervicothoracic injuries are characteristically more stable than upper cervical injuries but this cannot be assumed.…”

Section: Computerised Tomographymentioning

confidence: 99%

“…However, the sensitivity of directed CT following suspicious plain films decreases to 78% (specificity 91%) and the overall sensitivity of CT for spinal injury may only be 81%, significantly less than a cervical series [138]. Computerised tomogram sensitivity for injuries ranges from 92% to 98-100% [34,127,[136][137][138][139] and the specificity of directed CT may be 86-91% [34,138].…”

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%

“…In a series of 129 patients unable to be cleared on plain films, 52 (40.3%) were due to non-visualisation of the craniocervical junction [127]. Ross et al [34], Borock et al [123], Kirschenbaum et al [127], and Nunez et al [128,129] all describe missed upper cervical spine fractures following inadequate or false negative odontoid views, commonly in the context of head injury. Furthermore, the odontoid view is an anteroposterior projection of an injury typically displaced in the same plane as the X-rays.…”

mentioning

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: Computerised Tomographymentioning

confidence: 99%