T he treatment of subaxial cervical spine trauma is evolving. The development of cervical instrumentation and the proliferation of cervical fusion techniques have led to changes in the management of cervical trauma. Increasingly, cervical trauma is treated outside of tertiary or specialty care centers by physicians with varying levels of trauma care experience. These factors have lead to a significant variability in the management of cervical trauma. 2 The variability in management of traumatic injuries is due, in part, to the lack of a widely accepted
Alpesh A. Patel, Andrew Dailey, Darrel S. Brodke, Michael Daubs, Paul A. Anderson, R. John Hurlbert, Alexander R. Vacccaro, and the Spine Trauma Study Group
Langston T. Holly, Daniel F. Kelly, George J. Counelis, Thane Blinman, David L. McArthur, and H. Gill Cryer
I ndividuals who sustain traumatic brain injury are at increased risk of sustaining cervical spine injury compared with victims of nonhead-related blunt trauma injury. 13 The reported incidence of cervical spine trauma after clinically significant head injury has generally ranged from 4 to 8%. 11, 13, 19, 24 Although an increasing injury severity, as measured by the GCS, has been associated with a higher rate of cervical injury, few other risk factors in this patient population have been identified. 13, 24 Identifying such high-risk patients may be
Todd McCall, Dan Fassett, and Douglas Brockmeyer
✓ Injuries of the cervical spine are relatively rare in children but are a distinct clinical entity compared with those found in adults. The unique biomechanics of the pediatric cervical spine lead to a different distribution of injuries and distinct radiographic features. Children younger than 9 years of age usually have upper cervical injuries, whereas older children, whose biomechanics more closely resemble those of adults, are prone to lower cervical injuries. Pediatric cervical injuries are more frequently ligamentous in nature, and children are also more prone to spinal cord injury without radiographic abnormality than adults are. Physial injuries are specific only to children. Radiographically benign findings, such as pseudosubluxation and synchondrosis, can be mistaken for traumatic injuries. External immobilization with a halo brace can be difficult and is associated with a high complication rate because of the thin calvaria in children. Surgical options have improved with the development of instrumentation specifically for children, but special considerations exist, such as the small size and growth potential of the pediatric spine.
Report of 2 cases
Jodi L. Smith and Laurie L. Ackerman
motion in the cervical spines of young children can lead to devastating, often difficult to treat, cervical spine injuries. In this study, we present 2 cases of severe cervical spine trauma in young children restrained in car safety seats during a motor vehicle crash: 1) a previously healthy 14-month-old girl who was improperly restrained in a forward-facing booster seat secured to the vehicle by a lap belt, and 2) a previously healthy 30-month-old girl who was a rear seat passenger appropriately restrained in a car safety seat. In this study we point out the unique
Paul S. Page and Darnell T. Josiah
Traumatic vertebral artery injuries (TVAIs) are a common finding in cervical spine trauma and can predispose patients to posterior circulation infarction. While extensive research has been conducted regarding the management and criteria for imaging in patients with suspected blunt vascular injury, little research has been conducted highlighting these injuries in the geriatric population.
The authors performed a retrospective review of all patients evaluated at a level 1 trauma center and found to have TVAIs between January 1, 2010, and January 1, 2018. Biometric, clinical, and imaging data were obtained from a trauma registry database. Patients were divided into 2 groups on the basis of age, a geriatric group (age ≥ 65 years) and an adult group (age 18 to < 65 years). Variables evaluated included type of trauma, mortality, Injury Severity Score (ISS), and ICU length of stay. The Student t-test was used for continuous variables, and Pearson’s chi-square test was used for categorical variables.
Of the 2698 of patients identified with traumatic cervical spine injuries, 103 patients demonstrated evidence of TVAI. Of these patients, 69 were < 65 and 34 were ≥ 65 years old at the time of their trauma. There was no difference in the incidence of TVAIs between the 2 groups. The ICU length of stay (4.71 vs 4.32 days, p > 0.05), hospital length of stay (10.71 vs 10.72 days, p > 0.05), and the ISS (21.50 vs 21.32, p > 0.05) did not differ significantly between the 2 groups. Mortality was significantly higher in the geriatric group, occurring in 9 of 34 patients (26.5%) compared with only 3 of 69 patients (4.4%) in the adult group (p < 0.001). Ground-level falls were the most common inciting event in the geriatric group (44% vs 14.5%, p < 0.001), whereas motor vehicle accidents were the most common etiology in the younger population (72.5% vs 38.2%, p < 0.001). Incidence of ischemic stroke did not vary significantly between the 2 groups (p > 0.05).
TVAI in the older adult population is associated with a significantly greater risk of mortality than in the younger adult population, despite the 2 groups having similar ISSs. Additionally, low-velocity mechanisms of injury, such as ground-level falls, are a greater risk factor for acquired TVAI in older adults than in younger adults, in whom it is a significantly less common etiology.
Karl D. Schultz Jr, Mark R. McLaughlin, Regis W. Haid Jr, Christopher H. Comey, Gerald E. Rodts Jr, and Joseph Alexander
, Tator CH, et al: Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg 86: 990–997, 1997 34. Maiman D , Yoganandan N : Biomechanics of cervical spine trauma. Clin Neurosurg 37 : 543 – 570 , 1991 Maiman D, Yoganandan N: Biomechanics of cervical spine trauma. Clin Neurosurg 37: 543–570, 1991 35. Maurer PK , Ellenbogen RG , Ecklund J , et al : Cervical spondylotic myelopathy: treatment with posterior decompression and Luque rectangle bone
Brandon G. Chew, Christopher Swartz, Matthew R. Quigley, Daniel T. Altman, Richard H. Daffner, and James E. Wilberger
surgery of trauma practice management guidelines committee . J Trauma 67 : 651 – 659 , 2009 6 Daffner RH : Imaging of Vertebral Trauma ed 3 Cambridge , Cambridge University Press , 2011 . 181 – 191 7 Daffner RH , Sciulli RL , Rodriguez A , Protetch J : Imaging for evaluation of suspected cervical spine trauma: a 2-year analysis . Injury 37 : 652 – 658 , 2006 8 Davis JW , Kaups KL , Cunningham MA , Parks SN , Nowak TP , Bilello JF , : Routine evaluation of the cervical spine in head-injured patients with dynamic
Nikita G. Alexiades, Belinda Shao, Bruno P. Braga, Christopher M. Bonfield, Douglas L. Brockmeyer, Samuel R. Browd, Michael DiLuna, Mari L. Groves, Todd C. Hankinson, Andrew Jea, Jeffrey R. Leonard, Sean M. Lew, David D. Limbrick Jr., Francesco T. Mangano, Jonathan Martin, Joshua Pahys, Alexander Powers, Mark R. Proctor, Luis Rodriguez, Curtis Rozzelle, Phillip B. Storm, and Richard C. E. Anderson
T raction is an invaluable tool for the management of both cervical spine trauma and cervical spine deformity. The use of traction to achieve closed reduction, for example, is widely used in traumatic facet dislocations and odontoid fractures. 1–4 Furthermore, halo-gravity traction (HGT) has demonstrated benefit in the management of spinal deformity including basilar invagination, irreducible atlantoaxial rotatory subluxation, cervical kyphosis, and os odontoideum. 5–9 The overwhelming majority of existing literature that guides clinical practice is
Victoria Palmer, Randolph B. Cohen, Bruce Braffman, Douglas L. Brockmeyer, and Heather S. Spader
Osteomyelitis of the cervical spine is an exceedingly rare lesion in pediatric practice and is caused by a variety of mechanisms. The authors present a case in which cervical osteomyelitis presented in a delayed manner after the patient experienced a stable cervical extension injury at the C4–5 level. On review of the original images, the authors noted a likely perforation in the retropharyngeal space. This case highlights the risk of retropharyngeal injury in cervical trauma, with the seldom-seen complication of osteomyelitis as a result.
Ganesh Rao, Adam S. Arthur, and Ronald I. Apfelbaum
✓ Fractures of the craniocervical junction are common in victims of high-speed motor vehicle accidents; indeed, injury to this area is often fatal. The authors present the unusual case of a young woman who sustained a circumferential fracture of the craniocervical junction. Despite significant trauma to this area, she suffered remarkably minor neurological impairment and made an excellent recovery. Her injuries, treatment, and outcome, as well as a review of the literature with regard to injuries at the craniocervical junction, are discussed.