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Arthur B. Jenny, Ralph A. W. Lehman and Henry G. Schwartz

T uberculous infection of the cervical spine may seriously impair spinal stability since extensive destruction of multiple vertebrae usually occurs. Present principles of treatment include antibiotic therapy, debridement of necrotic bone and tissue, and osseous grafting with external stabilization until fusion occurs. This case report presents a successful result in which a potentially unstable tuberculous process was treated without grafting by simple drainage, antibiotic coverage, and external fixation. As in many previously reported spinal cases, 1

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Norman D. Peters and George Ehni

. Subsequent tomography of this region failed to adequately penetrate the thick shoulder mass of the patient at the C6–7 level, and provided no additional information. Fig. 1. Conventional oblique and lateral cervical spine radiographs with manual traction on both arms failed to image the level of injury. Fig. 2. Left: Oblique xeroradiogram showing compression fracture of C-7 and absence of dislocation. Right: Coned-down xeroradiogram demonstrating fractures of the superior facet, uncinate process, and body of C-7. Discussion

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Richard C. E. Anderson, Eric R. Scaife, Stephen J. Fenton, Peter Kan, Kris W. Hansen and Douglas L. Brockmeyer

C urrently , no national guidelines exist for clearance of the cervical spine in children after trauma. Even after a comprehensive scientific review was conducted and published in Neurosurgery as the “Management of Pediatric Cervical Spine and Spinal Cord Injuries” guidelines in 2002, 2 insufficient evidence was found to support diagnostic standards of care. Traditionally, clearance of the cervical spine after trauma has been performed by specialists in multiple disciplines including emergency department physicians, orthopedic surgeons, trauma surgeons

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Daniel K. Fahim, Keyne K. Johnson, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen and Andrew Jea

best of our knowledge, only 9 cases of chondromas located in the cervical spine have been reported in the English literature since 1965 ( Table 1 ). Only 2 of these reports involved a pediatric patient. Here we report on a 6-year-old boy with a symptomatic recurrent giant (> 7 cm in diameter) periosteal chondroma of the cervical spine that was treated with aggressive resection and anterior-posterior spinal reconstruction; we believe that this report documents the youngest patient diagnosed with and treated for a chondroma of the spine. TABLE 1: Published case

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Jeff S. Compton and Nicholas W. C. Dorsch

intradural extramedullary tuberculoma involving the cervical spine. The case is unusual in several respects, including the mode of presentation, as well as the site and nature of the lesion. It is the first such lesion to be investigated by computerized tomography (CT) scanning. Case Report This 45-year-old left-handed man presented to the casualty department after a motor-vehicle accident. He had been slowing to a stop when his car was struck from behind. He sustained a flexion-extension injury to his neck, and immediately suffered pain in the base of his cervical

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Narlin Beaty, Justin Slavin, Cara Diaz, Kyle Zeleznick, David Ibrahimi and Charles A. Sansur

B altimore City has one of the highest crime rates per capita in the US. 35 On average, the R Adams Cowley Shock Trauma Center treats 389 gunshot wounds (GSWs) annually. Consistent with data from other reviews of the literature, only a small minority of these injuries involve the cervical spine. 37 , 38 Over the last 12 years, the University of Maryland encountered an average of 10 cervical GSWs annually. Of those who suffer neurological injury, approximately 4 per year survive initial resuscitation. The inherent rarity and immediate morbidity of this

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John P. Kapp

E ndotracheal intubation for anesthesia carries significant risk in patients with fractures of the cervical spine. In most cases, the neck cannot be hyperextended without risk of injury to the spinal cord. Retropharyngeal edema and hematoma add further to the problem of visualization of the vocal cords and insertion of an endotracheal tube under direct vision. Patients who are anesthetized or curarized for intubation may be difficult to ventilate by mask and become hypoxic if initial attempts at orotracheal intubation are unsuccessful. Multiple attempts at

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Kyle T. Johnson, Wajd N. Al-Holou, Richard C. E. Anderson, Thomas J. Wilson, Tejas Karnati, Mohannad Ibrahim, Hugh J. L. Garton and Cormac O. Maher

O ur understanding of pediatric cervical spine development remains incomplete. Several previous studies have measured growth at single cervical segments 29 or at the craniovertebral junction, 18 , 25 , 30 as well as the growth of surgically relevant anatomy such as pedicles and lateral masses. 1 , 14 , 26 , 31 Other studies have analyzed growth of the subaxial vertebral bodies in patients between infancy and 10 years of age, 19 reporting morphometric data according to age groups spanning 2 or 3 years. A few studies have investigated alignment of the

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Daniel M. Sciubba, Michael J. Dorsi, Ryan Kretzer and Allan J. Belzberg

T he diagnostic performance of helical CT scanners for detecting cervical spine injury following blunt trauma has been shown to be excellent, with reported sensitivity as high as 99% and specificity as high as 93%. 4 , 5 , 14 Missed injuries are rare, usually ligamentous, and may only be detected with MR imaging or dynamic plain radiographs. In light of such diagnostic reliability and with improvements in the accessibility of helical CT within trauma centers and emergency departments, some authors propose using CT alone to assess for osseous and

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Roy P. Baker and Robert L. Grubb Jr.

A fracture-dislocation of the lower cervical spine in which the body of one vertebra lies entirely anterior to the adjacent body is unusual, and is generally accompanied by severe spinal cord injury. Lack of any permanent neurological deficit is very rare with this type of injury, and few such cases have been reported. 1, 3 We present a patient with a complete fracture-dislocation of C-6 on C-7 who sustained no permanent neurological deficit. The radiological findings, the treatment of the patient, and the proposed mechanism of injury are discussed. Case