CERVICAL SPINE INJURY.pptx

8/12/2019 CERVICAL SPINE INJURY.pptx

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Epidemiology

Cervicalspineinjury

MVA

Falls fromheight

AthleticParticipation

Act ofviolence

Neurologic Injury


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Upper Cervical Spine


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Lower Cervical Spine


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Denis Classification


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Mechanism Of Injury MVA (primarily in young patients), falls (primarily in

older patients), diving accidents, and blunt traumaaccount for the majority of cervical spine injuries.

Most cervical spine injurieForced flexion orextension.

Handbook of Fracture 3rdEdition


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Clinical Evaluation Basic principle in evaluation traumatized

patientassume the presence of possibly unstablespinal injury

C-Spine immobilization until determination of spinestability has been made

Brinker


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Radiographic evaluation Radiographic evaluation on C spine suggested in:

Patient with neck pain after significance injury

Prescence of facial fracture Polytrauma

Neurological deficits/symptoms

Altered mental status and history of possible trauma

Brinker


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ImagingAP view Open Mouth view


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Lateral view

Apley's System of Orthopaedics & Fractures - 9th Edition


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Upper Cervical Landmark


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OTA Classfication Of Cervical Spine

InjuryINJURIES TO THE OCCIPUT-C1-C2 COMPLEX

As with other transitional regions of the spine, the

craniocervical junction is highly susceptible to injury.This regions vulnerability to injury is particularly



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Occipital Condyle Fractures These are frequently associated with C1 fractures as

well as cranial nerve palsies.

The mechanism of injury involves compression andlateral bending

CT is frequently necessary for diagnosis.



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Anderson and Montesano classification of occipital condyle

fractures

(A) Type I injuries are comminuted, usually stable, impaction fractures caused byaxial loading. (B) Type II injuries are impaction or shear fractures extending intothe base of the skull, and are usually stable. (C) Type III injuries are alar ligamentavulsion fractures and are likely to be unstable distraction injuries of thecraniocervical junction.


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Cont Type I:Impaction of condyle; usually stable Type II:Shear injury associated with basilar or skull

fractures; potentially unstable

Type III:Condylar avulsion; unstable Treatment includesrigid cervical collar immobilization for 8 weeks for stableinjuries and halo immobilization or occipital-cervicalfusion for unstable injuries.



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Occipitoatlantal Dislocation

Classification based on the position of the occiput in relation toC1 is as follows: Type I:Occipital condyles anterior to the atlas; most common Type II:Condyles longitudinally dissociated from atlas without

translation; result of pure distraction Type III:Occipital condyles posterior to the atlas

The Harborview classification attempts to quantify stability ofcraniocervical junction. Surgical stabilization is reserved for typeII and III injuries.

Type I:Stable with displacement


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Immediate treatment includes halo vest applicationwith strict avoidance of traction. Reduction maneuversare controversial and should ideally be undertakenwith fluoroscopic visualization.

Long-term stabilization involves fusion between theocciput and the upper cervical spine.



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Atlas Fractures Classification (Levine)

Isolated bony apophysis fracture

Isolated posterior arch fracture Isolated anterior arch fracture

Comminuted lateral mass fracture

Burst fracture



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Initial treatment includes halo traction/immobilization.

Stable fractures may be treated with a rigid cervicalorthosis.

Less stable configurations may require prolonged haloimmobilization.

C1-C2 fusion may be necessary to alleviate chronicinstability and/or pain.



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Odontoid fracturesClassification (Anderson and DAlonzo) Type I An avulsion fracture of the tip of the odontoid

process due to traction by the alar ligaments. The fractureis stable (above the transverse ligament) and unites

without difficulty.Type II A fracture at the junction of the odontoid

process and the body of the axis. This is the most common(and potentially the most dangerous) type. The fracture isunstable and prone to non-union.

Type III A fracture through the body of the axis.The fracture is stable and almost always unites withimmobilization.


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Patients often present with neck pain, limited range ofmotion, and no neurologic injury.

The mechanisms of injury are axial compression andlateral bending.

CT is helpful for diagnosis.

A depression fracture of the C2 articular surface is

common. Treatment ranges from collar immobilization to late

fusion for chronic pain.

CERVICAL SPINE INJURY.pptx

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