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cervical spine (C-spine) injury
Etiology:
- cervical spine fracture
- intervertebral disc herniation
- dislocation
- ligament injury
Epidemiology:
- most fatal injuries occur at the craniocervical junction or at C1 or C2
Pathology:
1) flexion injury
2) flexion-rotation injury
3) extension injury
4) extension-rotation injury
5) vertical compression injury
6) lateral flexion injury
7) imprecisely understood mechanisms that may result in
a) odontoid fractures
b) atlanto-occipital dislocation
Clinical manifestations:
1) pain on movement of neck
2) lateral disk herniation
a) pain in ipsilateral shoulder, arm & hand
b) paresthesias
c) weakness depending upon involved nerve roots
d) reflexes may be diminished
e) cough, sneeze & downward compression on the head exacerbate pain
f) traction relieves pain
3) central disk protrusion with spinal cord compression
a) generally painless
b) may simulate degenerative disease (i.e. ALS)
Radiology:
- see cervical spine fracture
Differential diagnosis:
- cauda equina syndrome
- vertebral artery dissection
- hanging injuries & strangulation
- neck trauma
- cervical strain
- spinal cord neoplasm
- septic shock
- spinal cord infection
- thoracic outlet syndrome
- torticollis
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
Related
cervical myelopathy
cervical spine (C-spine)
cervical spine (C-spine) clearance
cervical spine fracture
General
spine trauma
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 79-80
- Davenport M
Cervical Spine Fracture in Emergency Medicine
http://emedicine.medscape.com/article/824380-overview