Cervical spine injuries

Assessment and early management

A Dismal Image

• Cord injury not treatable still

• Unpredictable outcome

• Prolonged course of treatment

• Psychosocial factors

Commonest and most devastating injury of axial skeletonCommonest and most devastating injury of axial skeleton

Spinal cord injuries

• Constitute 2-5 % OF all blunt trauma • 40-50 cases / million • 40 % of cervical spine injuries have

cord involvement • Cost factor

Initial management

steps• Haemodynamic

stabilization• Cervical collar• X-ray • CT scan • MRI• Steroids

• Traction• Secondary

exam

• ICU admission • Prevention of

DVT

• Physiotherapy

Initial management steps

Eratic practice

• Variations • Cross table xray• Unconcious pt• high resolution imaging • cost and morbidity

Guide lines

• British trauma society working party

immobilization

• Critera for risk• Teqnique• Spine boards• Log rolling• Transfer slides

Special circumstances

• Neck not neutral• Unco-operative pt• Vomiting• Intubation• Transfer to another hospital

Exclusion criteriaclinical

• Alertness• Head injury• No alcohol or drugs• No neck pain• No neurology• No distracting injury

Plain xrays

• Ap• Lateral• open mouth• Oblique• Other views

Ct scan

• Targeted 2-3 mm• Whole • multi slice ct

Mri scan

• Ligaments ,disc and neural tissue • In unconciuos pts

Dynamic studies

• Flexion and extension xrays • Or fluroscopy

Unconcious

• In line immobilization• Mri• Dynamic • Ct

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