Cervical spine trauma: etiology, management and outcome

The present work aimed to study Cx-Sp.T. regarding the etiology, available management lines and their reflection on the patient's outcome. Fifty patients of Cx-Sp.T. admitted to the Neurological Department over a period of 15 months from January 2000 to March 2001 [mean age 34.8 +/- 7.4 years, 38 males and 12 females] were included in this study. Immediate first aid, medical treatment and neck support were provided to every patient. Data about the trauma etiology were recorded. ASIA scale was used for a neurological assessment on admission. All patients were imaged with PI-X-ray, MRI was used once it possible [46 patients]. Skull traction was applied for all unstable cases. Anterior cervical decompression realignment and vertebral fixation using anterior plating and screws were performed in cases with bony fusion in almost all of them. Follow up continued for at least 12 months. The patients were classified, regarding their final outcome, based on ASIA scale into satisfactory, unsatisfactory or death. Road traffic accidents and falling from height accounted for 62% and 32% of the cases with two sport injuries and one due to assault. Initially, 24% of the cases suffered from complete cord syndrome, 64% had complete cord syndrome, while only 12% were neurologically intact on admission, 14% of the patients had no fractures. Stable and unstable fractures constituted 22% and 64% of the cases. Fifteen patients received conservative management, while 32 of the cases were operated upon. The outcome of the patients was satisfactory in 34% and unsatisfactory in 58% with 8% mortalities, three of them were immediate and one postoperative. Rapid commencement of accurately decided lines of management and neural decompression together with vertebral realignment and stabilization is crucial in lowering down the unsatisfactory results