The Relationship between Spinal Stenosis and Neurological Outcome in Traumatic Cervical Spine Injury: An Analysis using Pavlov's Ratio, Spinal Cord Area, and Spinal Canal Area

BACKGROUND: This study examined the relationship between four radiological parameters (Pavlov's ratio, sagittal diameter, spinal cord area, and spinal canal area) in patients with a traumatic cervical spine injury, as well as the correlation between these parameters and the neurological outcome. METHODS: A total of 212 cervical spinal levels in 53 patients with a distractive-extension injury were examined. The following four parameters were measured: Pavlov's ratio on the plain lateral radiographs, the sagittal diameter, the spinal cord area, and the spinal canal area on the MRI scans. The Pearson correlation coefficients between the parameters at each level and between the levels of each parameter were evaluated. The correlation between the radiological parameters and the spinal cord injury status classified into four categories, A (complete), B (incomplete), C (radiculopathy), and D (normal) was assessed. RESULTS: The mean Pavlov's ratio, sagittal diameter, spinal cord area and spinal canal area was 0.84, 12.9 mm, 82.8 mm2 and 236.8 mm2, respectively. An examination of the correlation between the radiological spinal stenosis and clinical spinal cord injury revealed an increase in the values of the four radiological parameters from cohorts A to D. Pavlov's ratio was the only parameter showing statistically significant correlation with the clinical status (p = 0.006). CONCLUSIONS: There was a correlation between the underlying spinal stenosis and the development of neurological impairment after a traumatic cervical spine injury. In addition, it is believed that Pavlov's ratio can be used to help determine and predict the neurological outcome.

A Clinical Analysis and Treatment of Traumatic Cervical Spine Patients

The authors reviewed 90 patients with traumatic cervical spine injury admitted to our department between January, 1993 and December, 1997. The most common age group was 21-30 years old. The male to female ratio was 7.2 : 1. Motor vehicle accident was the most frequent cause of traumatic cervical spine injury. The most common mechanism of injury was compressive and then distractive flexion. The C2 body fracture was the commonest of the vertebral body fractures and C5/6 dislocation was the most common involved level of injured vertebrae. Forty-seven of these patients were managed with conservative treatment and the remaining 43 patients underwent surgery. The conservative treatment was consisted of skeletal traction, neck collar and Halo-vest application. Of 43 patients operated, 24 patients were performed by anterior approach and 10 by posterior approach and remaining 9 patients were treated by anterior approach after posterior approach. According to Modified Frankel's grading system, the rates of neurological impr-ovement at anterior approach, posterior approach and combined approach were 79.2%, 60.0% and 66.0%, respec-tively. Difference of improvement rates did not have clinical significance. There were 76 types of associated injuries were observed in 51 patients. The most common associated injury was head trauma and surgical intervention was required in 5 patients among them. The common complications were respiratory disorder, bed sore, urinary tract infection, gastrointestinal bleeding, pin site infection in decreasing order of frequency. The most common cause of death was respiratory disorder including pneumonia, atelectasis, acute respiratory distress syndrome and pulmonary edema.

Clinical Analysis of the Result of Halo Immobilization Versus Surgical Fusion in the Management of Traumatic Cerical Spine Injury

In the mamagement of cervical spine injuries, it is difficult to determine when to use halo immobilization alone, surgical fusion alone or a combination of the two. To investigate the appropriate condition and relative effectiveness of the treatment of cervical spine injuries, a 3-year retrospective analysis was conducted. During this study the authors reviewed the medical records and X-rays of 46 patients with cervical spine injuries treated with either halo immobilization or surgical fusion. Eighteen patients were treated with the initial surgical fusion, yielding a fusion failure rate of 22%. On the other hand, the remaining 28 patients were initially treated with the halo immobilization, yielding a fusion failure rate of 35%. The main fracture types in patients that require surgical fusion after failure with halo immobilization were hyperflexion anterior subluxation and locked facet injuries. From these findings, we concluded that halo immobilization of hyperflexion anterior subluxation injury and unilateral or bilateral locked facet results in relatively high failure rates and therefore treatment by initial surgical fusion should be the method of choice. Close monitoring is mandatory following halo vest with any type of fracture and level.