synonyms: cervical spine trauma,
Cervical Spine Trauma ICD-9
Cervical Spine Trauma Etiology / Epidemiology / Natural History
- Typically high energy trauma
- Associated the American Football, spear tackling.
Cervical Spine Trauma Anatomy
Cervical Spine Trauma Clinical Evaluation
- Palpate entire spine for tenderness / step off.
- Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
- Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
- See ASIA form.
Cervical Spine Trauma Xray / Diagnositc Tests
- Lateral c-spine generally taken as part of ATLS for patients who are unstable.
- A/P, Lateral, Odontoid, views indicated for high risk patients: (1)older than 65y/o, (2)paresthesias in the extremities, (3) dangerous injury mechansim. Imaging is not required in low-risk patients who ccan activtely rotate the neck 45° to the right and left. Low-risk:(1)simple rear end collision, able to maintain sitting position, (3)ambulatory, (4) delayed onset neck pain, (5)absence of midline c-spine tenderness. (Stiell IG, JAMA 2001;286:1841).
- CT cervical spine: indicated for obtunded patients before c-spine clearance. Better cost-effectivness, sensitiivty and safety than screening xrays, but exposes patients to 6x more radiaiton.
- MRI: indicated for neuro deficit, suspicious of instability or HNP, pre-op evaluation
Cervical Spine Trauma Classification / Treatment
- Any trauma pt with suspected C-spine injury should be immobilized on a spine board with cervical collar and log-roll precautions until the c-spine has been cleared.
- Protective equipement such as the helmet and shoulder pads should be left in place. Removal risks progressive neurologic injury from a potentially unstable cervical spine injury. Removal of the face mask alone is typically performed allow airway access.
- C-spine Fracture/dislocatio, closed reduction in awake, cooperative patient: closed reduction with Gardner-Wells tongs/traction with serial neuro exams and xrays.
- See Differential Diagnosis for specific injuries / treatments.
Cervical Spine Trauma Differential Diagnosis
- Occipital Condyle Fracture
- Occipitocervical Dissociation
- Atlas fracture
- C2 fracture
- Odontoid fracture
- Facet Dislocation
- Facet Fracture
- Burst Fracture
- Compression Fracture
- Teardrop Fractures
- Spinal Cord Injury
Cervical Spine Trauma Complications
Cervical Spine Trauma Follow-up Care
Cervical Spine Trauma Review References
- Boden BP, Tacchetti RL, Cantu RC, Knowles SB, Mueller FO. Catastrophic cervical spine injuries in high school and college football players. Am J Sports Med. 2006 Aug;34(8):1223-32.
- Mall NA, Buchowski J, Zebala L, Brophy RH, Wright RW, Matava MJ. Spine and axial skeleton injuries in the National Football League. Am J Sports Med. 2012 Aug;40(8):1755-61.
- Rihn JA, Anderson DT, Lamb K, Deluca PF, Bata A, Marchetto PA, Neves N,Vaccaro AR. Cervical spine injuries in American football. Sports Med. 2009;39(9):697-708.