Management of cervical spine injuries in patients with ankylosing spondylitis

✓ Eleven patients with ankylosing spondylitis and traumatic fracture/dislocation of the spine were identified in a retrospective review of all cases of cervical spine injury treated on the neurosurgical service over a 10-year period. Injury was most often secondary to minor trauma or a motor-vehicle accident, and the level of vertebral involvement was most frequently between C-5 and T-1. Neurological symptoms at presentation ranged from neck pain alone to complete loss of function distal to the level of injury. Initial routine treatment consisted of axial traction for realignment with the minimal weight needed to accomplish this, taking into account the flexion deformity. All patients underwent pluridirectional tomography and/or computerized tomography to delineate the exact sites of injury. Three patients died shortly after admission due to pulmonary complications. The remaining eight patients underwent early posterior stabilization and mobilization in a halo or cervicothoracic brace to achieve fusion. Neurological improvement was achieved in six of these eight cases. The experience described here supports the initiation of axial traction as initial therapy for cervical injuries followed by early surgical stabilization in patients with ankylosing spondylitis. The difficulty of maintaining spinal alignment and the devastating pulmonary problems attendant on conservative management may be obviated by early fusion.

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Paramedic Documentation of Indicators for Cervical Spine Injury

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00040826 ◽

1994 ◽

Vol 9 (1) ◽

pp. 40-43 ◽

Cited By ~ 10

Author(s):

Andre M. Pennardt ◽

Wm. John Zehner

Keyword(s):

Emergency Department ◽

Cervical Spine ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Spinal Injury ◽

Medical Center ◽

Prehospital Care ◽

Retrospective Chart Review ◽

Spine Injury ◽

Status Assessment

AbstractIntroduction:Current paramedic training mandates complete immobilization of all patients, symptomatic or not, whose mechanism of injury typically is viewed as conducive to spinal trauma. It is common to observe confrontations between paramedics and walking, asymptomatic accident victims who fail to understand why they should “wear that collar and be strapped to that board.” Immobilized, frustrated patients then may wait for hours in a busy emergency department until a physician declares them to be without spinal injury. Patients frequently refuse treatment and transport.Hypothesis:Algorithms exist for physicians to “clear” the cervical spine (C-spine) without radiography. It was hypothesized that paramedics routinely assess and document these indicators in their patient evaluations.Methods:A retrospective chart review was conducted on 161 patients (Group 1) admitted to a regional medical center with a diagnosis of C-spine injury over a 52-month period. The charts of 225 motor vehicle accident (MVA) victims (Group 2) transported by ambulance to the emergency department over a five-month period then were studied. Indicators for C-spine injury documented by emergency medical service (EMS) personnel were abstracted.Results:All patients underwent mental status assessment and full spinal immobilization (neck and back) by EMS crews prior to transport to the hospital. Two or more indicators of possible C-spine injury were documented on each prehospital care report (PCR).Conclusion:Paramedics already assess most, if not all, of the criteria standard to C-spine clearance algorithms, but are inconsistent in their documentation of the presence or absence of all of the relevant findings.

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LO027: Cervical spine injury in trauma patients 65 years and older immobilised in the prehospital setting

CJEM ◽

10.1017/cem.2016.64 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S39-S39

Author(s):

L. Lamy ◽

J. Chauny ◽

D. Ross

Keyword(s):

Cervical Spine ◽

Cervical Spine Injury ◽

Fracture Dislocation ◽

Spine Injury ◽

Trauma Patients ◽

Minor Trauma ◽

Cervical Injury ◽

Geriatric Population ◽

Spinal Immobilisation ◽

A Minor

Introduction: Following a protocol derived from the Canadian C-spine Rule (CCR), patients 65 years and older transported by ambulance after trauma require full spinal immobilisation. Immobilisation complicates the transport and the evaluation; potential side effects have been recognized. The aim of this study was to evaluate the effect of mechanism of trauma and age on the rate of cervical injury in a geriatric population. Methods: We conducted a retrospective observational study on patients 65 years and older transported by ambulance to a level-one trauma center from March 2008 to October 2013. The outcome was the rate of clinically important cervical spine injury (CICSI), defined as any fracture, dislocation or ligamentous injury needing treatment or specialised follow up. The rate was calculated in the geriatric population and in the subgroup of patients with minor trauma, defined as a fall from a standing height, a chair or a bed. We then looked at the rate of CICSI based on age to define a subgroup at lower risk of lesion. Results: We included 1221 patients with a mean age of 80 y.o. (SD = 8), 739 women (61%). CICSI was found in 53 patients (4.3%, 95% CI 3.2-5.4). This is similar to the rate found in patients 65 years and older in the NEXUS population (4.6%) and the CCR population (6.0%). The mechanism of injury was a minor trauma for 716 patients (59%). Of those, 24 patients (3.4%, 95% CI 2.1-4.7) had CICSI. The rate increased after 85 y.o in both the overall population (3.4% vs 6.4%) and the minor trauma subgroup (2.6% vs 4.4%). Conclusion: The subgroup of patients 65-84 y.o. with a minor trauma had the lower rate of cervical spine injury (2.6%). In a lot of prehospital systems, those patients are not systematically immobilised for transport. It will be interesting to review the files of all patients with CICSI to identify any possible case that would have been missed without the age criteria.

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Cervical vertebral injuries associated with the ossification of the posterior longitudinal ligament: Imaging features

Acta Radiologica Open ◽

10.1177/2058460117695855 ◽

2017 ◽

Vol 6 (3) ◽

pp. 205846011769585 ◽

Cited By ~ 1

Author(s):

Tetsuo Nakayama ◽

Shigeru Ehara

Keyword(s):

Cervical Spine ◽

Posterior Longitudinal Ligament ◽

Fracture Dislocation ◽

Spine Injury ◽

Spine Fractures ◽

Minor Trauma ◽

Imaging Features ◽

Cervical Fractures ◽

Different Types ◽

Cervical Spine Fractures

Background Spinal injuries associated with ossification of the posterior longitudinal ligament (OPLL) have been characterized. However, the imaging features of traumatic cervical spine fractures in patients with OPLL have not been assessed adequately. Purpose To characterize the patterns of traumatic cervical spine fractures associated with different types of OPLL. Material and Methods We retrospectively analyzed the patterns of fractures resulting from cervical spine injury in patients with OPLL of different types and assessed the fracture patterns in patients with ankylosed segments. Results Twenty-six patients (23 men, 3 women; median age, 67.0 years; age range, 43–87 years) were included. Fall from a height <3 m was the most common trauma. Contiguous type OPLL was seen in 11 patients (42%), segmental type in 11 (42%), and mixed type in four (15%). Four of the contiguous OPLL and one of the mixed OPLL patients had ankylosed segments. The incidence of cervical fractures was 69% (16/26): seven (64%) in contiguous OPLL, five (46%) in segmental OPLL, and in all four patients with mixed OPLL. Unilateral interfacetal fracture-dislocation was most common (4/16); the others were bilateral interfacetal fracture-dislocation, fractures through the ankylosed segment, transdiscal fractures, isolated facet fractures, and compression fractures. Cervical fractures were exclusively observed in the C4 to C7, except in one case occurred at the C2 level. Conclusion Interfacetal fracture-dislocation in the lower cervical vertebrae constitutes the most common injury resulting from minor trauma.

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Circumferential fixation with craniofacial miniplates for a cervical spine injury in a child

Journal of Neurosurgery Pediatrics ◽

10.3171/2009.6.peds0913 ◽

2009 ◽

Vol 4 (5) ◽

pp. 429-433 ◽

Cited By ~ 7

Author(s):

Neal B. Patel ◽

Matthew A. Hazzard ◽

Laurie L. Ackerman ◽

Eric M. Horn

Keyword(s):

Cervical Spine ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Spinal Instrumentation ◽

Spine Injury ◽

Cervical Spine Injuries ◽

Pediatric Age Group ◽

Locking Mechanism ◽

Vertebral Bodies ◽

Cervical Spine Alignment

Unstable pediatric cervical spine injuries present significant challenges in terms of fixation. Given the smaller cervical vertebral bodies in the preschool-aged population, commercially available pediatric cervical fixation instrumentation may be unsuitable because of the inappropriately large size of the screws and plates. The authors describe a 2-year-old girl who sustained an unstable C6–7 distraction injury during a motor vehicle accident. Because of the small size of her vertebral bodies, standard cervical spine instrumentation was not feasible, and posterior wiring alone was believed to be insufficient because of the complete distraction of all 3 spinal columns. The patient was taken to the operating room where craniofacial plates with an inherent locking mechanism were used to circumferentially stabilize the cervical spine. Follow-up examination 6 months postoperatively demonstrated stable cervical spine alignment and fusion with no evidence of the failure of either the anterior or posterior hardware. The use of craniofacial miniplates with an intrinsic locking mechanism represents a superior alternative for both anterior and posterior cervical fixations when spinal instrumentation is needed in the pediatric age group.

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Traumatic thoracolumbar fracture–dislocation in an infant: surgical management using posterior thoracolumbar instrumentation

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa279 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Ali Alkhaibary ◽

Sami Khairy ◽

Wael Alshaya

Keyword(s):

Surgical Management ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Spinal Fracture ◽

Fracture Site ◽

Thoracolumbar Fracture ◽

Fracture Dislocation ◽

Cord Injury ◽

Traumatic Fracture ◽

Complete Spinal Cord Injury

Abstract Spinal fracture–dislocation in the infantile population is a rare phenomenon, and its surgical management remains poorly discussed in the literature. This article reports a case of traumatic fracture–dislocation in an infant by outlining the surgical management and extensively reviewing the literature. An 8-month-old girl was involved in a motor vehicle accident and was ejected from the car through the windshield. Radiological imaging demonstrated a complete spinal cord injury at the level of T10 and a three-column fracture of T12-L1, with an evidence of kyphosis measuring 47° at the fracture site. Posterior thoracolumbar instrumentation, using the posterior cervical fixation set, was successfully performed. In experienced neurosurgical centers, posterior thoracolumbar instrumentation can be safely performed in infants with traumatic thoracolumbar fracture–dislocation. This allows for the correction of the kyphotic deformity, facilitation of the rehabilitation course and improvement in the health-related quality of life.

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Cervical spine fracture-dislocation in patients with ankylosing spondylitis and severe thoracic kyphosis: application of halo vest before and during surgical management

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2021.106744 ◽

2021 ◽

pp. 106744

Author(s):

Haisong Yang ◽

Haibin Wang ◽

Bangke Zhang ◽

Yuling Sun ◽

Liang Wang ◽

...

Keyword(s):

Cervical Spine ◽

Ankylosing Spondylitis ◽

Surgical Management ◽

Thoracic Kyphosis ◽

Spine Fracture ◽

Fracture Dislocation ◽

Cervical Spine Fracture ◽

Halo Vest

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Cervical spine fracture following a motor vehicle accident

Journal of Emergency Medicine ◽

10.1016/0736-4679(88)90322-8 ◽

1988 ◽

Vol 6 (3) ◽

pp. 179-183 ◽

Cited By ~ 2

Author(s):

William F. Eckhardt ◽

Michael Doyle ◽

Alan Woodward ◽

Irwin Freundlich ◽

Francis X. Rockett

Keyword(s):

Cervical Spine ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Spine Fracture ◽

Cervical Spine Fracture ◽

Vehicle Accident

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Intradural extramedullary tuberculoma of the cervical spine

Journal of Neurosurgery ◽

10.3171/jns.1984.60.1.0200 ◽

1984 ◽

Vol 60 (1) ◽

pp. 200-203 ◽

Cited By ~ 31

Author(s):

Jeff S. Compton ◽

Nicholas W. C. Dorsch

Keyword(s):

Cervical Spine ◽

Motor Vehicle ◽

Motor Vehicle Accident ◽

Ct Scanning ◽

Nerve Roots ◽

Content Type ◽

Vehicle Accident ◽

Calcified Lesion ◽

Intradural Extramedullary ◽

Fine Print

✓ A case is reported of a 45-year-old man who developed quadriplegia following a trivial motor-vehicle accident. Investigation including computerized tomography (CT) of the cervical spine revealed a large calcified lesion displacing the spinal cord and nerve roots, which proved to be a tuberculoma. The case is unusual in regard to the age of the patient, the size, location, and nature of the lesion, the mode of presentation, and the delineation of the lesion by CT scanning.

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