cervical spine fracture

Etiology: - trauma - motor vehicle accidents Epidemiology: - 1/3 occur at C2 - 1/2 occur at C6 or C7 - most fatal injuries occur at the craniocervical junction or at C1 or C2 Radiology: - computed tomography - recommended for routine screening of cervical spine injury - very sensitive - can identify even subtle fractures - magnetic resonance imaging - modality of choice to detect spinal cord injury - sensitive for detecting lesions of both neural tissue & bone Management: - first aid - spinal immobilization for patients with major trauma & patients whose mechanism of injury is not clear - cervical spine immobilization device - logroll technique when transferring the patient onto a long spine board or rescue board - once in the hospital - remove the patient from the board as soon as practical - some patients develop decubitus ulcers after 1 hour - cervical spine clearance - supportive care - ABC & immobilization - maintain hemodynamic stability - high dose glucocorticoids may be of benefit - administer within 8 hours of injury - methylprednisolone 30 mg/kg bolus, then 5.4 mg/kg/hr after 1 hour for 23 hours - conflicting reports, risk of infection - orthopedic surgery &/or neurosurgery consult - goals of surgery - decompress the spinal cord canal - stabilize the disrupted vertebral column

General

vertebral fracture; spine fracture

References

Davenport M Cervical Spine Fracture in Emergency Medicine http://emedicine.medscape.com/article/824380-overview

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