Airway Compression as a Result of Extensive Prevertebral Hematoma Following Extension Injury of Lower Cervical Spine without Fracture/Dislocation / 대한정형외과학회잡지

A 77-year-old man presented with severe dyspnea, neck pain, tingling sensation in both hands, and weakness after an acute prevertebral soft tissue hematoma due to distractive-extension injury. Magnetic resonance images demonstrated an extensive hematoma accumulation, anterior longitudinal ligament and longus colli muscle injuries. We report here a case of dyspnea due to an extensive prevertebral hematoma by soft tissue injury without cervical vertebral fracture and/or dislocation and a review the relevant literature.

The Relationship between Soft Tissue Damages and Neurologic Deficits in Distractive Extension Injury of the Lower Cervical Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the relationship between the damage to anterior soft tissues and neurological deficit in distractive extension injury of the lower cervical spine. MATERIALS AND METHODS: Ninety-two patients who were treated surgically for distractive extension injury of the lower cervical spine were included in this study. Soft tissue swelling was evaluated on plain radiographs. Damage to the longus colli muscle, anterior longitudinal ligament, superior end plate, inferior end plate, annulus fibrosus, and posterior longitudinal ligament were intraoperatively checked and the relationship between these findings and clinical neurologic deficits was analyzed. RESULTS: Soft tissue swelling was increased to 92% in the retropharyngeal space and to 89% in the retrotracheal space but there was no significant difference. No relationship was found between the damage to the prevertebral fascia, longus colli muscle and neurological deficit. Injuries to the inferior end plate and annulus fibrosus showed a directly propotional relation with neurological deficit, but it was not significant. Injuries to the anterior longitudinal ligament (p<0.01), superior end plate (p=0.02), posterior longitudinal ligament (p=0.04) showed significant relations with neurological deficit. CONCLUSION: The distractive extension injury combined with the damage to the anterior longitudinal ligament, superior end plate or posterior longitudinal ligament showed high frequency of neurological deficit. Hence, these are regarded as the important structures for maintaining the stability of the lower cervical spine.

Soft Tissue Damage in Cervical Spine Extension Injury / 대한정형외과학회잡지

PURPOSE: To diagnose the extent of soft tissue damage with MRI, and to evaluate the relationship between soft tissue damage and a spinal cord injury in an extension injury to the lower cervical spine trauma. MATERIALS AND METHODS: Eighty-one patients who treated surgically for an anextension injury to the cervical spine over the past 5 years, were analyzed. All patients had undergone MRI after the injury, and for the specific grading of soft tissue damage, the grades were defined from grades 1 to 5. RESULTS: The spinal cord injury developed with more than grade 3 soft tissue damage associated with a rupture of the posterior longitudinal ligament (p<0.01). The changes in signal intensity of the spinal cord also developed according to the severity of soft tissue damage (p<0.01). There was no relationship between the soft tissue damage and the spinal cord injury in spinal stenosis (p=0.75). CONCLUSION: The extent of soft tissue damage was diagnosed precisely with MRI, and there was an close relationship between the soft tissue damage and spinal cord injury in the distractive- extension injury to the lower cervical spine trauma.

Diagnosis in Extension Injuries of the Lower Cervical Spine / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate diagnostic criteria using plain lateral radiography, the incidence of traumatic disc herniation and the degree of neurologic deficit in extension injury of the lower cervical spine. MATERIALS AND METHODS: We analyzed 28 patients with extension injury of the lower cervical spine, by measuring the retropharyngeal, retrotracheal space and the intervertebral space at the injured level in plain lateral radiography. We selected 40 patients as a control group for the prevertebral soft tissue space measurement. RESULTS: Widening was found in the retropharyngeal space (6.8 +/-2.9 mm) and in the retrotracheal space (15.2 +/-3.8 mm) compared with the control group (4.2 +/-0.7 mm, 12.6 +/-1.9 mm, p<0.05). No significant increase in the injured intervertebral space was observed with respect to the normal upper and lower disc space. Neurologic deficit occurred in 25 cases (89%); with root injury in 11 cases and cord injury in 14 cases. There were 19 posterior disc herniations (68%), which were associated with neurologic deficits in all cases. CONCLUSION: Extension injuries should be suspected in the presence of soft tissue injury of the anterior column without fracture or dislocation by the radiologic study of the lower cervical spine. Magnetic resonance imaging study is believed to be an essential diagnostic modality for the accurate evaluation and proper management of the lower cervical spine injuries.