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Cervical Spine Trauma

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Abstract

The following chapter will review in progression basic concepts of cervical trauma assessment and primary management and then address the more level-specific concerns separated into an upper and a lower cervical spine subsection.

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References

  1. Chapman J, Smith JS, Kopjar B, et al. The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976). 2013;38:1098–104.

    Article  Google Scholar 

  2. Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA. 2009;301:513–21.

    Article  CAS  PubMed  Google Scholar 

  3. Vos T, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800.

    Article  Google Scholar 

  4. Rustagi T, Drazin D, Oner C, York J, Schroeder GD, Vaccaro AR, Oskouian RJ, Chapman JR. Fractures in ankylosing disorders: a narrative review of disease and injury types, treatment techniques, and outcomes. J Orthop Trauma. 2017;31:S57–74.

    Article  PubMed  Google Scholar 

  5. Avellino AM, Mann FA, Grady MS, Chapman JR, Ellenbogen RG. The misdiagnosis of acute cervical spine injuries and fractures in infants and children: the 12-year experience of a level I pediatric and adult trauma center. Childs Nerv Syst. 2005;21(2):122–7.

    Article  PubMed  Google Scholar 

  6. Tchorz KM. Advanced trauma life support (ATLS®): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363.

    Google Scholar 

  7. Curran C, Dietrich AM, Bowman MJ, Ginn-Pease ME, King DR, Kosnik E. Pediatric cervical-spine immobilization: achieving neutral position? J Trauma: Inj Infect Crit Care. 1995;39(4):729–32.

    Article  CAS  Google Scholar 

  8. Manoach S, Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: historical review and current questions. Ann Emerg Med. 2007;50(3):236–45.

    Article  PubMed  Google Scholar 

  9. Pekmezci M, Theologis AA, Dionisio R, Mackersie R, McClellan RT. Cervical spine clearance protocols in Level I, II, and III trauma centers in California. Spine J. 2015;15(3):398–404.

    Article  PubMed  Google Scholar 

  10. Hoffman JR, Wolfson AB, Todd K, Mower WR, For the NEXUS Group. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998;32(4):461–9.

    Article  CAS  PubMed  Google Scholar 

  11. Child Z, Rau D, Lee MJ, Ching R, Bransford RJ, Chapman JR, Bellabarba C. The provocative radiographic traction test for diagnosing craniocervical dissociation: a cadaveric biomechanical study and reappraisal of the pathogenesis of instability. Spine J. 2016;16(9):1116–23.

    Article  PubMed  Google Scholar 

  12. Grauer JN, Vaccaro AR, Lee JY, Nassr A, Dvorak MF, Harrop JS, Dailey AT, Shaffrey CI, Arnold PM, Brodke DS, Rampersaud R. The timing and influence of MRI on the management of patients with cervical facet dislocations remains highly variable: a survey of members of the Spine Trauma Study Group. J Spinal Disord Tech. 2009;22(2):96–9.

    Article  PubMed  Google Scholar 

  13. Grant GA, Mirza SK, Chapman JR, Winn HR, Newell DW, Jones DT, Grady MS. Risk of early closed reduction in cervical spine subluxation injuries. J Neurosurg Spine. 1999;90(1):13–8.

    Article  CAS  Google Scholar 

  14. Hurlbert RJ. Strategies of medical intervention in the management of acute spinal cord injury. Spine. 2006;31(11S):S16–21.

    Article  PubMed  Google Scholar 

  15. Fehlings MG, the Spine Focus Panel Summary Statement. The use of methylprednisolone in acute spinal cord injury. Spine. 2001;26(24S):S55.

    Article  CAS  PubMed  Google Scholar 

  16. Hurlbert RJ. The role of steroids in acute spinal cord injury: an evidence-based analysis. Spine. 2001;26(24S):S39–46.

    Article  CAS  PubMed  Google Scholar 

  17. Mirza SK, Krengel WF III, Chapman JR, Anderson PA, Bailey JC, Grady MS, Yuan HA. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res. 1999;359:104–14.

    Article  Google Scholar 

  18. Fehlings MG, Perrin RG. The timing of surgical intervention in the treatment of spinal cord injury: a systematic review of recent clinical evidence. Spine. 2006;31(11S):S28–35.

    Article  PubMed  Google Scholar 

  19. Furlan J, Noonan V, Cadotte DW, Fehlings DW. Timing of decompressive surgery of spinal cord after traumatic spinal cord injury: an evidence-based examination of pre-clinical and clinical studies. Spine. 2001;26(24S):S39–46.

    Google Scholar 

  20. Fehlings MG, Vaccaro AR, Wilson JR, Singh A, Cadotte DW, Harrop JS, Aarabi B, Shaffrey CI, Dvorak M, Fisher C. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7:e32037. https://doi.org/10.1371/journal.pone.0032037.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Bliemel C, et al. Early or delayed stabilization in severely injured patients with spinal fractures? Current surgical objectivity according to the Trauma Registry of DGU: treatment of spine injuries in polytrauma patients. J Trauma Acute Care Surg. 2014;76(2):366–73.

    Article  PubMed  Google Scholar 

  22. Carreon LY, Dimar JR. Early versus late stabilization of spine injuries: a systematic review. Spine. 2011;36(11):E727–33.

    Article  PubMed  Google Scholar 

  23. Westerveld LA, van Bemmel JC, Dhert WJ, Oner FC, Verlaan JJ. Clinical outcome after traumatic spinal fractures in patients with ankylosing spinal disorders compared with control patients. Spine J. 2014;14(5):729–40.

    Article  CAS  PubMed  Google Scholar 

  24. Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine (Phila Pa 1976). 2010;35(11):E458–64.

    Article  Google Scholar 

  25. Gelb DE, et al. Treatment of subaxial cervical spinal injuries. Neurosurgery. 2013;72:187–94.

    Article  PubMed  Google Scholar 

  26. Wiseman DB, Bellabarba C, Mirza SK, Chapman JR. Anterior versus posterior surgical treatment for traumatic cervical spine dislocation. Curr Opin Orthop. 2003;14(3):174–81.

    Article  Google Scholar 

  27. Reis A, Bransford RJ, Penoyar T, Chapman JR, Bellabarba C. Diagnosis and treatment of cranio-cervical dissociation in 48 consecutive survivors. Evid Based Spine Care J. 2010;1(2):69–70.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ivancic PCS. Do cervical collars and cervicothoracic orthoses effectively stabilize the injured cervical spine? A biomechanical investigation. Spine. 2013;38(13):E767–74.

    Article  PubMed  Google Scholar 

  29. Mirza SK, Moquin RR, Anderson PA, Tencer AF, Steinmann J, Varnau D. Stabilizing properties of the halo apparatus. Spine (Phila Pa 1976). 1997;22(7):727–33.

    Article  CAS  Google Scholar 

  30. Bransford RJ, Stevens DW, Uyeji S, Bellabarba C, Chapman JR. Halo vest treatment of cervical spine injuries: a success and survivorship analysis. Spine. 2009;34(15):1561–6.

    Article  PubMed  Google Scholar 

  31. Anderson PAULA, PASQUALE X. Montesano. Morphology and treatment of occipital condyle fractures. Spine. 1988;13(7):731–6.

    Article  CAS  PubMed  Google Scholar 

  32. Gire JD, et al. The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Spine J. 2013;13(5):510–9.

    Article  PubMed  Google Scholar 

  33. Walters BC, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60(CN_suppl_1):82–91.

    Article  PubMed  Google Scholar 

  34. Powers B, et al. Traumatic anterior atlanto-occipital dislocation. Neurosurgery. 1979;4(1):12–7.

    Article  CAS  PubMed  Google Scholar 

  35. Harris JH Jr, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994;162(4):881–6.

    Article  PubMed  Google Scholar 

  36. Harris JH Jr, et al. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994;162(4):887–92.

    Article  PubMed  Google Scholar 

  37. Wackenheim A. Roentgen diagnosis of the craniovertebral region. Berlin/New York: Springer; 1974.

    Google Scholar 

  38. Benzel EC. Biomechanics of spine stabilization. 3rd ed. New York: Thieme Medical Publishers; 2015.

    Google Scholar 

  39. Hall GC, et al. Atlanto-occipital dislocation. World J Orthop. 2015;6(2):236.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Spence JR, Kenneth F, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. JBJS. 1970;52(3):543–9.

    Article  Google Scholar 

  41. Dickman CA, Greene KA, Sonntag VKH. Injuries involving the transverse atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38(1):44–50.

    Article  CAS  PubMed  Google Scholar 

  42. Dvorak J, et al. Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res. 1988;6(3):452–61.

    Article  CAS  PubMed  Google Scholar 

  43. Hadley MN, et al. Acute traumatic atlas fractures: management and long term outcome. Neurosurgery. 1988;23(1):31–5.

    Article  CAS  PubMed  Google Scholar 

  44. Anderson LD, D’Alonzo RT: Fractures of the odontoid process of the axis. J Bone Joint S. 1974;56(8):1663–74.

    Article  CAS  Google Scholar 

  45. Malik SA, et al. Evaluation of morbidity, mortality and outcome following cervical spine injuries in elderly patients. Eur Spine J. 2008;17(4):585–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Ryan MD, Henderson JJ. The epidemiology of fractures and fracture-dislocations of the cervical spine. Injury. 1992;23(1):38–40.

    Article  CAS  PubMed  Google Scholar 

  47. Tashjian RZ, et al. Halo-vest immobilization increases early morbidity and mortality in elderly odontoid fractures. J Trauma Acute Care Surg. 2006;60(1):199–203.

    Article  Google Scholar 

  48. Fehlings MG, et al. Predictors of treatment outcomes in geriatric patients with odontoid fractures: AOSpine North America multi-centre prospective GOF study. Spine. 2013;38(11):881.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Chapman J, et al. The AOSpine North America Geriatric Odontoid Fracture Mortality Study: a retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine. 2013;38(13):1098.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Andersson S, Rodrigues M, Olerud C. Odontoid fractures: high complication rate associated with anterior screw fixation in the elderly. Eur Spine J. 2000;9(1):56–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Levine AM, Edwards CC. The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg (Am Vol). 1985;67(2):217–26.

    Article  CAS  Google Scholar 

  52. Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1–27.

    Article  Google Scholar 

  53. Harris JH Jr, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin North Am. 1986;17(1):15–30.

    PubMed  Google Scholar 

  54. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA Jr, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex. Spine (Phila Pa 1976). 2007;32(21):2365–74.

    Article  Google Scholar 

  55. Vaccaro AR, Koerner JD, Radcliff KE, Oner FC, Reinhold M, Schnake KJ, et al. AOSpine subaxial cervical spine injury classification system. Eur Spine J. 2016;25(7):2173–84.

    Article  PubMed  Google Scholar 

  56. Schneider RC, Kahn EA: The significance of the acute flexion or “tear-drop” fracture dislocation of the cervical spine. JBJS. 1956;38(5):985–97.

    Google Scholar 

  57. Como JJ, Diaz JJ, Dunham CM, Chiu WC, Duane TM, Capella JM, et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma. 2009;67(3):651–9.

    Article  PubMed  Google Scholar 

  58. Andreshak JL, Dekutoski MB. Management of unilateral facet dislocations: a review of the literature. Orthopedics. 1997;20(10):917–26.

    CAS  PubMed  Google Scholar 

  59. Daffner SD, Daffner RH. Computed tomography diagnosis of facet dislocations: the “hamburger bun” and “reverse hamburger bun” signs. J Emerg Med. 2002;23(4):387–94.

    Article  PubMed  Google Scholar 

  60. Gomes S, Rudkin S, Tsai F, Lotfipour S. Bilateral cervical spine facet fracture-dislocation. West J Emerg Med. 2009;10(1):19.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Harrigan MR, Hadley MN, Dhall SS, Walters BC, Aarabi B, Gelb DE, et al. Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery. 2013;72(Suppl 2):234–43.

    Article  PubMed  Google Scholar 

  62. Nadeau M, McLachlin SD, Bailey SI, Gurr KR, Dunning CE, Bailey CS. A biomechanical assessment of soft-tissue damage in the cervical spine following a unilateral facet injury. J Bone Joint Surg Am. 2012;94(21):e156.

    Article  PubMed  Google Scholar 

  63. Rasoulinejad P, McLachlin SD, Bailey SI, Gurr KR, Bailey CS, Dunning CE. The importance of the posterior osteoligamentous complex to subaxial cervical spine stability in relation to a unilateral facet injury. Spine J. 2012;12(7):590–5.

    Article  PubMed  Google Scholar 

  64. Sonntag VK. Management of bilateral locked facets of the cervical spine. Neurosurgery. 1981;8(2):150–2.

    Article  CAS  PubMed  Google Scholar 

  65. Spector LR, Kim DH, Affonso J, Albert TJ, Hilibrand AS, Vaccaro AR. Use of computed tomography to predict failure of nonoperative treatment of unilateral facet fractures of the cervical spine. Spine (Phila Pa 1976). 2006;31(24):2827–35.

    Article  Google Scholar 

  66. Kepler CK, Vaccaro AR, Chen E, Patel AA, Ahn H, Nassr A, et al. Treatment of isolated cervical facet fractures: a systematic review. J Neurosurg Spine. 2016;24(2):347–54.

    Article  PubMed  Google Scholar 

  67. Jack A, Hardy-St-Pierre G, Wilson M, Choy G, Fox R, Nataraj A. Anterior surgical fixation for cervical spine flexion-distraction injuries. World Neurosurg. 2017;101:365–71.

    Article  PubMed  Google Scholar 

  68. Kwon BK, Fisher CG, Boyd MC, Cobb J, Jebson H, Noonan V, et al. A prospective randomized controlled trial of anterior compared with posterior stabilization for unilateral facet injuries of the cervical spine. J Neurosurg Spine. 2007;7(1):1–12.

    Article  PubMed  Google Scholar 

  69. Gelb DE, Aarabi B, Dhall SS, Hurlbert RJ, Rozzelle CJ, Ryken TC, et al. Treatment of subaxial cervical spinal injuries. Neurosurgery. 2013;72(Suppl 2):187–94.

    Article  PubMed  Google Scholar 

  70. Fehlings MG, Vaccaro A, Wilson JR, Singh A, Cadotte DW, Harrop JS, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  71. Gelb DE, Hadley MN, Aarabi B, Dhall SS, Hurlbert RJ, Rozzelle CJ, et al. Initial closed reduction of cervical spinal fracture-dislocation injuries. Neurosurgery. 2013;72(Suppl 2):73–83.

    Article  PubMed  Google Scholar 

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Chapman, J.R., Jack, A.S., Ramey, W.L. (2020). Cervical Spine Trauma. In: O'Brien, J., Kalantar, S., Drazin, D., Sandhu, F. (eds) The Resident's Guide to Spine Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-20847-9_36

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  • DOI: https://doi.org/10.1007/978-3-030-20847-9_36

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