Presentation on theme: "Larry D. Dodge, MD. Clinical Evaluation Proper Immobilization Assume a spine injury with head or neck trauma 3 to 25% of spinal cord injuries occur."— Presentation transcript:
Larry D. Dodge, MD
Clinical Evaluation Proper Immobilization Assume a spine injury with head or neck trauma 3 to 25% of spinal cord injuries occur after initial traumatic episode.
Ankylosing Spondylitis or DISH Increased risk of fracture even with minor trauma Frequent through ossified disk space Obtain a CAT scan Very unstable – spinal cord injuries.
Asymptomatic Trauma Patient Cervical x-rays not required in patients without tenderness and are alert.
Trauma Patients with Neck Pain 2 to 6% incidence of significant spine injuries.
Do Not Remove Collar Until Absence of tenderness Absence of pain Normal mental status complete radiographic evaluation
Most Common Missed Diagnosis Occipitoathlantoaxial region or cervicothoracic junction Plain x-ray will miss 15 to 17% of injuries
CAT scan has 99% predictive value MRI better for soft tissue, may be oversensitive
Flexion and Extension Radiographs Safe in awake alert patients Exclude significant instability
Obtunded Patient Evaluation Controversial MRI- limited usefulness, lack of correlation between MRI and significant injury Passive flexion – extension x-ray – possible iatrogenic injury Combination of CAT and plain x-ray probably standard.
Fractures of the Cervical Spine Most do not require surgery Ligamentous injuries less predictable, and more require surgery
Types of Orthrosis Halo- the best, especially at upper cervical Soft collars – little immobilization Semi rigid- ( Miami J, Philadelphia, Aspen) – still allow motion 8-12 weeks of immobilization required with follow-up flexion and extension x-ray.
Occipitocervical Dissocation Most are lethal Neurologic injuries vary from complete to cranial nerve injuries Diagnosis can be difficult Occipitocervical fusion is required
Axis Fractures Odontoid fractures are most common Type I – Avulsion Type II – Waist Type III – Vertebral body
Type Odontoid Treated with external orthrosis
Type Odontoid Controversial treatment Elderly do not tolerate halo – consider C1- C2 fusion Fusion needed if reduction not achieved or maintained
Type Odontoid High healing rate with halo vest
Traumatic Spondylolisthesis of Axis MVA- hyperextension, compression and rebound flexion Most treated in halo
Subaxial Compression Fractures Failure of anterior column Orthosis for 6 – 12 weeks
Subaxial Burst Fracture Fracture into posterior cortex with retropulsion Spinal cord injury rate is high Most require surgery – anterior or anterior and posterior
Facet Dislocations Timely reduction required Subluxation of 25% suggests unilateral, 50% suggests bilateral MRI needed to assess for HNP Failure of closed reduction mandates open reduction
Cervical Disk Disease Symptoms can be insidious or acute Minor injured can aggravate the root (radiculopathy) or spinal cord ( myelopathy)
Pathophysiology Disk loses water and proteoglycan content changes – less able to support load Decreased disk height leads to loss of lordosis Osteocartilaginous overgrowth occurs in response to increased load – stenosis develops
Cervical Roots exhibit a higher degree of overlap than seen in the thoracolumbar spine, therefore symptom patterns may fail to localize.