The ao spine knowledge forum trauma was given the task to develop and validate a new classification system. Brownsequard syndrome of the cervical spinal cord after. Trauma clinical guideline cervical spine injury evaluation. Cervical spine injuries are the most feared of all spinal injuries because of the potential for serious neurologic sequelae. Possible presentations include neck pain, limited range of motion, andor neurological deficit. Cervical spine assessment this guideline has been adapted for statewide use with the support of the victorian paediatric clinical network all children under 16 years of age with major trauma including confirmed or highly suspected spinal cord injury should have ongoing management at royal childrens hospital.
Pediatric cervical trauma overview spine orthobullets. The degree of incorporation of evidencebased guidelines into protocols at trauma centers in. In the absence of ct, plain xrays remain effective at evaluating for cervical spine misalignment, fracture, and prevertebral softtissue measurements. Awake patient gcs15 without cervical tenderness and no distracting injury. Inclusion criteria were children younger than 5 years of age, a confirmed diagnosis of nonaccidental trauma, and cervical spine mr imaging within 1 week of presentation. Prehospital cervical spinal immobilization after trauma. Presentation cervical spine vertebral column vertebra. Imaging of the upper cervical spine is crucial for injury detection, description, and. A patient with possible c spine injury as defined in section 1 above usually based on mechanism may have their cervical spine cleared without further radiologic evaluation if all of the following conditions exist. General considerations most spinal fractures are due to a single episode of major trauma. Box 2208, iraklion, 71003 crete, greece and department of natural sciences, technological education institute of crete. Clicking on the pink text box will bring up the full text. Preventing agerelated bone loss osteoporosis can be used as a prophylactic treatment to help prevent cervical injuries related to fractured vertebrae. The importance of detecting cervical spine injury is obvious because failure to do so can.
Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim. Spinal cord injury without radiographic abnormality has been found to occur in 0. Characteristics of injuries to the cervical spine and. This study shows the usual prevalence of cervical spine injury after blunt trauma, but adds some interesting information regarding distracting injury. Radiology of the cervical spine in trauma patients. This guideline has been adapted for statewide use with the support of the victorian paediatric clinical network all children under 16 years of age with major trauma including confirmed or highly suspected spinal cord injury should have. Ct reliably excludes most fractures, however suffers from the inability to evaluate many acute types of disc injury, as well as any neurological injury. March 2015 background injury to the cervical spine is a common occurrence in the polytrauma patient. We conducted a casecontrol study of children younger than 16 years, presenting after blunt trauma, and who received cervical spine radiographs at 17 hospitals in the pediatric emergency care applied research. The rationale for maintaining a high suspicion for spinal cord injury in the trauma patient is clearly discussed. To evaluate cervical spine clearance protocols in level 1 trauma centers in the united states summary of background data. Most trauma centers have an algorithm for clearance, or even two, like my center. More effective than xray for evaluation of cervical spine alignment, possibility of fracture, or softtissue swelling.
Imaging of cervical spine trauma tudor h hughes, m. While cervical spine injury is more common in patients with multiple injuries. Motor vehicle collisions are the predominant mechanism in children under 8 years old. Trauma constitutes a significant portion of emergency department practice. Following an episode of significant trauma, the supporting structures of the cervical spine often require definitive imaging. In a series of 400 patients with fractures andor dislocations of the cervical spine, 25% had hyperextension and 19% hyperflexion fracturedislocations. Cervical spine trauma clinical practice guidelineprotocol the contents of this clinical practice guideline are to be used as a guide. The emergent evaluation of patients at risk relies on standardized clinical and radiographic. One such type of cervical injury is a brachial plexus injury, which make up approximately 10% of all cervical. Acute cervical spine trauma investigations bmj best practice. Morbidity and mortality related to cervical spine injuries depend on the mechanism of injury and the level of traumatic insult. A high index of suspicion and proper investigation is required to detect bone or l.
Spinal and cranial trauma metropolitan neurosurgery. Recent hypotheses regarding the mechanism of recovery include neuronal plasticity mechanisms denervation supersensitivity, collateral fig 1. Cervical and thoracolumbar spine injury evaluation. This type of treatment is almost always urgent and nonelective, exclusively for victims of accident or assault. For cervical injuries resulting from arthritis or agerelated disc degeneration, it may be more difficult to find a longterm solution. In the current aospine trauma classification, the spinal column is divided into 4 regions. It is imperative that the diagnosis be made as early as possible after arrival to the hospital. Acute cervical spine trauma differentials bmj best practice. Cervical mr imaging has demonstrated a utility for detecting soft tissue injury in nonaccidental trauma. Anderson, md t he standard of care in imaging of the spine in trauma patients is constantly changing with the increasing avail. Results of canadian c spine study z8924 patients enrolled z100 % sensitivity for identifying 151 clinically important c spine injuries z42. While cervical spine injury is more common in patients with multiple injuries, isolated injury may occur following comparatively minor traumatic incidents. Cervical collars should be removed as soon as feasible after trauma.
Basic principles of management for cervical spine trauma. The guideline incorporates the validated canadian c spine rules. Cervical injuries have to do with trauma to the cervical spine, located in your neck. Traumarelated spine conditions childrens hospital of. Jan 23, 2019 mri cervical spine without iv contrast is usually appropriate as the next imaging study after ct cervical spine without iv contrast for obtunded patients 16 years or older with suspected suspected acute blunt trauma of the cervical spine and no traumatic injury identified on cervical spine ct.
Disclosure statement i have no financial conflicts of interest to disclose. Ct reliably excludes most fractures, however suffers from the inability to evaluate many acute. Mechanism of injury is highly variable, ranging from seemingly innocuous falls to highenergy motor vehicle accidents. Traumarelated spine conditions result in fractures, sprains and dislocations of bones in the spinal column. Healthcare professionals should use sound clinical judgment and individualize patient care. Cervical spine clearance guideline page 1 of 2 pages last revised. Child abuse should also be considered in the young child with a suspected whiplash mechanism of. While children rarely have spinal injuries and even less frequently have spinal cord injuries, certain activities do put children at risk for such injuries.
Insufficiency fractures typically involve cancellous bone in. Purpose 14 december 2011 predecisional fouo 2 this presentation is based on the cervical and thoracolumbar spine injury cpg, 05 aug 2016 id. Measurement techniques for upper cervical spine injuries. Presentation cervical spine free download as powerpoint presentation.
Box 2208, iraklion, 71003 crete, greece and department of natural sciences, technological education institute of. The purpose of this study was to identify the incidence and types of cervical spine injury on mr imaging in nonaccidental trauma and to correlate cervical spine injury with parenchymal injury on brain mr imaging and findings on head ct. Pearls and pitfalls accurate diagnosis of acute cervical spine injury requires cooperation between clinician and radiologist, a reliable and repeatable approach to interpreting cervical spine ct, and the awareness that a patient may have a significant and unstable ligamentous injury despite normal findings. Cervical spine evaluation in pediatric trauma posterior one third of the dens fig. Fatigue fractures of the spine are unusual except in the pars interarticularis of children. Guidelines for the management of acute cervical spine and spinal cord injuries. Modality of choice for patients with suspected cervical spine injury. Greater morbidity results from higher levels of cervical spine injury, with craniocervical junction injuries being associated with the highest. Symptomatic trauma patients options if an awake patient has neck pain or tenderness and normal cspine xray including ct as needed, discontinue ccollar after normal flexex films normal mri within 48 hours. C ervical spine injury csi is rare in children, accounting for only 12% of pediatric trauma. Mr imaging of the cervical spine in nonaccidental trauma. Cervical spine clearance upstate medical university. The powers ratio is calculated by dividing the distance between the basion and posterior arch of c1 by the distance between the opisthion and anterior arch of c1.
Insufficiency fractures typically involve cancellous bone in the axial skeleton and are. Spinal stabilization and management zprotect spine at all times during the management of patients with multiple injuries. Cranial and spinal trauma refers to any type of injury sustained by the central nervous system or associated skeletal features, the skull and spine. Please refer to the complete cpg for detailed instructions. Prehospital cervical spinal immobilization after trauma in. Metropolitan neurosurgery offers comprehensive neurosurgical care and, in the agonizing situations necessitating these types. The guideline incorporates the validated canadian cspine rules. But anytime different clinicians or centers do the same thing in different ways, it.
Cervical spine clearance protocols were developed to prevent missed injuries that could result in neurological deficits. As the authors come from the central europe, their. Upper cervical spine trauma abstract injuries to the upper cervical spine are potentially lethal. Arthritic symptoms can be treated with antiinflammatory. Cervical spine trauma is a topic covered in the pediatric surgery nat to view the entire topic, please sign in or purchase a subscription apsa pediatric surgery library combines pediatric surgery not a textbook nat with apsa expert, a powerful platform for earning moc cme credits all powered by unbound medicine. Cervical spine clearance in trauma duke emergency medicine residency, pgy1 lecture series joseph m reardon, md with thanks to sarah crosby, mbbs. The technique and critical importance of careful assessment is described. Articles are free with membership this radiology continuing education article navigates the radiographer through radiographic imaging of the cervical spine. Cervical spine trauma remains one of the most severe musculoskeletal injuries with high mortality and disability. Although cervical spine trauma is more common following high velocity. Instability is defined, and the incidence of a second injury is highlighted. Prehospital cervical spine immobilization in trauma. Cervical spine clearance is another one of those tasks that everyone seems to do their own way.
Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteoligamentous instability with spinal cord injury. This pathway provides guidance on imaging patients at risk of a cervical spine injury following trauma. Nicholas theocharopoulos department of medical physics, faculty of medicine, university of crete, p. Factors associated with cervical spine injury in children. Must include c7t1 5% of c spine injuries three view trauma series flexionextension controversial as to timing only in cooperative alert patient with pain and negative 3 view negative study does not rule out injury if painful, keep immobilized, reevaluate. A low gcs indicates a high risk for a concomitant cervical injury. Basically, clinical examination will miss about 1% of patients with a negative exam, regardless of distracting injury status.
Injuries to the cervical and thoracic spine can lead to neurological problems. Ct is now considered the primary imaging modality and if suitable ct scans are available, xrays need not be performed. Such patients often have suspected cervical spine injury necessitating cervical spine radiographs. A, lateral plain radiograph of the cervical spine shows spondy. The two most common groups of combined traumatic conditions of the cervical spine are hyperextension and hyperflexion fracturedislocations. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries. The importance of detecting cervical spine injury is obvious because failure to do so can lead to tragic consequences for patient and physician alike. Acute cervical spine trauma investigations bmj best. Cervical spine clearance protocols in level 1 trauma. Initial radiographic evaluation of the spine after trauma. Therefore, the study suggests that clinical clearance. Characteristics of injuries to the cervical spine and spinal cord in polytrauma patient population.
104 976 864 306 649 1517 1329 517 436 149 207 506 1140 636 1422 565 1573 593 801 31 74 1410 1415 753 368 1068 1132 611 432 448 868 1339 1231 684 806 112 876 1419 441 633 772 141 794 1013 789 119