Subaxial Cervical Spine Injuries

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Subaxial Cervical Spine Injuries

Subaxial Cervical Spine Injuries: Introduction

  • Common cause of disability
  • Most common causes:–  RTA, Fall, Penetrating trauma, Sports
  • Highly prone to traumatic injury:
  • Mobile, relatively unprotected, and its high position
  • 60% of all spinal injuries occur in the cervical spine
  • Subaxial cervical spine injuries include:
    • 2/3rd of all cervical fractures
    • 75% of all cervical dislocations
  • One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7.

Subaxial Cervical Spine Injuries: Epidemiology

  • Bimodal Peak
  • Adolescents and Young Adults
  • Middle Aged Individuals (55 years)
  • Males accounts for 80% of injuries

Epidemiology of Subaxial Cervical Spine Injuries
Epidemiology of Subaxial Cervical Spine Injuries

Subaxial Cervical Spine Anatomy

  • Subaxial Spine: C3 – C7 segments
  • Denis’ 3 columns- Anterior, middle and Posterior
    • Anterior- ALL, Ant 2/3 rd  body & disc
    • Middle- Post 1/3rd of body & disc, PLL
    • Posterior- Pedicle, lamina, facet, transverse process,  spinous process, Ligaments-Interspinous, lig.flavum
  • Posterior column most important for stability
  • Encasement of the vertebral arteries generally from C1 through C6 via the transverse foramina
  • C7 has a transverse foramen, but the paired vertebral arteries generally do not course through them
  • Exiting root corresponds to the lower vertebra (C6 root exits the C5-6) foramen
  • C6 transverse process harbors an anterior tubercle : chassaignac tubercle –> carotid artery
  • Most common injury happen at C6 or C7 level :
    • exposed to great axial compression and flexion loads due to its location
    • transition from a very mobile cervical to a rigid thoracic spine.

Subaxial Cervical Spine Injuries: 3 column model of Denis
Subaxial Cervical Spine Injuries: Allen's Classification Cervical Spine Injuries
Subaxial Cervical Spine Injuries: Anatomy of Cervical Spine and Cervical Spine Injuries
Subaxial Cervical Spine Injuries: Anatomy of Cervical Spine and Cervical Spine Injuries

Cervical Spine : Radiological Anatomy

Subaxial Cervical Spine Injuries: Anatomy of Cervical Spine and Cervical Spine Injuries
Subaxial Cervical Spine Injuries: Anatomy of Cervical Spine and Cervical Spine Injuries
Subaxial Cervical Spine Injuries: Types of Cervical Spine Injuries

Mechanism of Subaxial Cervical Spine Injuries

Mechanism Cervical Spine Injuries

Subaxial Cervical Spine Injuries: Clinical Features

  • Neck pain
  • Restriction of neck movements
  • Neck tenderness
  • Varying degrees of neurological deficits
    • Complete cord syndrome
    • Incomplete cord syndrome
    • Central cord syndrome
    • Brown-Sequard syndrome
    • Anterior cord syndrome
    • Combination of the above

Spinal Cord Injury Without Radiographic Abnormality (SCIWORA)

  • Initially described by Pang et al, in 1982
  • Spinal cord dysfunction without the presence of any fracture, dislocation, or ligamentous injury on x-rays or CT scans
  • 20% to 35% of all paediatric spinal injuries
  • Due to elastic ligamentous laxity and the immaturity of osseous structures
  • can be an indication for MRI when there is a persisting, objective myelopathy after a traumatic event with normal plain film and CT findings
  • Other related terms used to describe specific situations with advent of new imaging techniques
    • Spinal cord injury without radiographic evidence of trauma (SCIWORET)
    • SCIWOCTET (spinal cord injury without CT evidence of trauma)
    • spinal cord injury without neuroimaging abnormality (SCIWONA): patients without traumatic signs using radiographs, CT and MRI.
    • more accepted general term SCIWORA is usually used to describe all variants of clinico-radiological mismatches.

ASIA Impairment Scale

Subaxial Cervical Spine Injuries: ASIA  Cervical Spine Injuries

Subaxial Cervical Spine Injuries Classifications

Classification Subaxial Cervical Spine Injuries
Holdsworth Classification Subaxial Cervical Spine Injuries
Allen Classification Subaxial Cervical Spine Injuries

AO Subaxial Cervical Spine Injuries Classification

AO Classification Subaxial Cervical Spine Injuries
AO Classification Cervical Spine Injuries
Type A AO Classification Cervical Spine Injuries
Type A AO Classification Cervical Spine Injries
Type A AO Classification Cervical Spine Injries
Type A AO Classification Cervical Spine Injries
Type A AO Classification Cervical Spine Injries
Type B AO Classification Cervical Spine Injries
Type B AO Classification Cervical Spine Injries
Type B AO Classification Cervical Spine Injries
Type B AO Classification Cervical Spine Injries
Type C AO Classification Cervical Spine Injries
Type C AO Classification Cervical Spine Injries
Facet AO Classification Cervical Spine Injries
Facet AO Classification Cervical Spine Injries
Facet AO Classification Cervical Spine Injries
SLIC Classification Cervical Spine Injries
SLIC Classification Cervical Spine Injries
Management Cervical Spine Injries

Subaxial Cervical Spine Injuries Management

  • All trauma patients are considered to have a cervical spine injury until proven otherwise
  • Cervical spine clearance : confirming the absence of cervical spine injury
  • It is important to clear cervical spine and remove collar in an efficient manner
  • delayed clearance associated with increased complication rate
  • cervical clearance can be performed with
    • physical exam
    • radiographically

NEXUS Low risk criteria

Cervical spine imaging recommended for all pts with trauma
�EXCEPT�
  • No midline tenderness
  • No intoxication
  • Normal alertness
  • No FND
  • No distracting injuries (eg Upper torso injuries may be sufficiently painful to distract from a reliable cervical spine examination)
*Hoffman JR et al. Ann Emerg Med 1998;32:461-469 �

Missed cervical spine injuries

  • may lead to permanent disability
  • careful clinical and radiographic evaluation is paramount
  • high rate of missed cervical spine injuries due to
    • inadequate imaging of affected level
    • loss of consciousness
    • multisystem trauma
  • cervical spine injury necessitates careful examination of entire spine
  • noncontiguous spinal column injuries reported in 10-15% of patients

Clinical Cervical Clearance

Removal of cervical collar WITHOUT radiographic studies allowed if
  • patient is awake, alert, and not intoxicated
AND
  • has no neck pain, tenderness, or neurologic deficits
AND
  • has no distracting injuries

Radiographic Cervical Clearance

Management Cervical Spine Injuries
Management Cervical Spine Injuries
Management Cervical Spine Injuries
Management Cervical Spine Injuries
Management Cervical Spine Injuries
Non Operative Management Cervical Spine Injuries

Operative Treatment for Cervical Spine Surgeries

Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of Surgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries
Indications of SUrgery Non Operative Management Cervical Spine Injuries

References

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