CERVICAL TRAUMA
Journal Title: Journal of Turkish Spinal Surgery - Year 2003, Vol 14, Issue 1
Abstract
Mechanism of injury: Most cervical spine fractures can be classified on the basis of the mechanism of injury. The forces and mechanism that produce the spine fracture vary according to the level of injury, A sever flexion or extension force is responsible for occipital and atlas injuries. Axial loading is accountable for the majority of fractures of the ring of C1. Rotation and hyper flexion most often account for injury at the atlantoaxial level. Hyperextension and axial loading are believed to be the most common cause of spondylolisthesis of the axis, and further injury may be associated with a second force of anterior flexion and compression. Injuries to the lower cervical spine may occur secondary to the forces of flexion, extension, lateral rotation, axial loading, or a combination of these forces. Patient evaluation In the multitrauma settings, patients should be considered to have cervical spine injury until completion of the secondary physical examination and thorough radiographic assessment. Noncontiguous spinal injuries occur in % 5 to % 20 of these with spine fractures. Palpation of the spine from the skull to the coccyx for areas of localized tenderness is extremely helpful to localize a spinal injury in a cooperative patient. Root specific muscle strength testing of the upper and lower extremities and rectal examination for tone and sensation are extremely important in determining an anatomic level of injury. cranial nerve examination, determination of sensation and pin and light touch, and determination of deep tendon and plantar reflexes complete the spine injury assessment. The presence of sensory sparing should be documented. If present, it indicates a potentially hopeful prognosis. Absence of primitive reflexes, such as the bulbocavernosus reflex or anal wink, in the first 48 hours indicates that neurological deficit may be related to spinal shock or contusion rather than to a complete and permanent spinal cord injury.
Authors and Affiliations
Cüneyt ÞAR
Keywords
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