Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review.

INTRODUCTION: Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients. METHODS: A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis. RESULTS: The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI. DISCUSSION: Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate. IMPLICATIONS FOR PRACTICE: MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI.

Neurosurgery compared to orthopedic spine consultation: A single level I trauma center experience.

Introduction: Both Orthopedic Surgery (OS) and Neurosurgery (NS) perform spine surgery in the setting of trauma. However, it is unknown whether outcomes differ between these specialties. This study compares management and outcomes for vertebral fractures between NS and OS, hypothesizing similar operation rate, length of stay (LOS), and readmission. Research question: Do outcomes differ between NS and OS in the management of vertebral fractures following trauma? Methods: A retrospective single-center study was conducted on adult patients with cervical, thoracic, lumbar, and sacral fractures treated at a single trauma center, where no standardized pathway exists across NS and OS. Patients were compared for injury profile, diagnostic imaging, and operative techniques as well as LOS, mortality, and complications. Results: A total of 630 vertebral fracture patients (OS:350 (55.6%); NS:280 (44.4%)) were included. NS utilized magnetic resonance imaging (MRI) more commonly (36.4% vs. 22.6%, p < 0.001). NS patients more often underwent operation (13.2% vs. 7.4%, p = 0.016) despite similar fracture number and severity (p > 0.05). Post-operative complications, LOS, and readmission rates were similar between cohorts (p > 0.05). Discussion and conclusion: Despite similar injury profiles, NS had higher rates of MRI usage and operative interventions in the context of traumatic spine fractures. Despite differences in management, major clinical outcomes were similar between NS and OS. However, we do call for further standardization of evaluation and treatment of patients based on established algorithms from such as the AOSpine Thoracolumbar Spine Injury Classification System (ATLICS).

Lumbar Spine Ganglion Cyst: A Case Report.

Ganglion cysts are typically periarticular soft tissue lesions commonly found in the wrist and forearm, with spinal involvement being rare. We present a clinical case of a 54-year-old female with a ganglion cyst at the L3-L4 level, causing radiculopathy symptoms. Despite initial difficulty in diagnosis due to MRI findings, surgical resection confirmed the extradural mass as a ganglion cyst. Postoperative recovery was uneventful, with immediate relief of radiculopathy symptoms. Challenges included distinguishing between synovial and ganglion cysts and accurately locating the cyst intraoperatively. This case highlights the importance of considering ganglion cysts in the differential diagnosis of spinal lesions and underscores the efficacy of surgical management for symptomatic relief.

Rethinking cervical spine clearance in obtunded trauma patients: An updated systematic review and meta-analysis.

BACKGROUND: Cervical spine injuries (CSI) are often challenging to diagnose in obtunded adult patients with blunt trauma and the optimal imaging modality remains uncertain. This study systematically synthesized the last decade of evidence to determine the type of imaging required to clear the c-spine in obtunded patients with blunt trauma. METHODS: A systematic review with meta-analysis was conducted and reported using PRISMA 2020 guidelines. The protocol was registered on June 22, 2022 (PROSPERO CRD42022341386). MEDLINE (Ovid), EMBASE, and Cochrane Library were searched for studies published between January 1, 2012, and October 17, 2023. Studies comparing CT alone to CT combined with MRI for c-spine clearance were included. Two independent reviewers screened articles for eligibility in duplicate. Meta-analysis was conducted using a random-effect model. Risk of bias and quality assessment were performed using the ROBINS-I and QUADAS-2. The certainty of evidence was assessed using the GRADE methodology. RESULTS: 744 obtunded trauma patients from six included studies were included. Among the 584 that had a negative CT scan, the pooled missed rate of clinically significant CSI using CT scans alone was 6 % (95 % CI: 0.02 to 0.17), and the pooled missed rate of CSI requiring treatment was 7 % (95 % CI: 0.02 to 0.18). High heterogeneity was observed among included studies (I² > 84 %). The overall risk of bias was moderate, and the quality of evidence was low due to the retrospective nature of the included studies and high heterogeneity. CONCLUSIONS: Limited evidence published in the last decade found that CT scans alone may not be sufficient for detecting clinically significant CSI and injuries requiring treatment in obtunded adult patients with blunt trauma. IMPLICATIONS OF KEY FINDINGS: Clinicians should be aware of the limitations of CT scans and consider using MRI when appropriate. Future research should focus on prospective studies with standardized outcome measures and uniform reporting.

Nursing practice and effect evaluation of cupping therapy in the rehabilitation of sports-induced cervical spine injuries

Cupping has been extensively used in the treatment of various medical conditions since antiquity. In this randomized controlled trial, we investigated the effects of wet cupping therapy on the outcomes of football athletes with cervical spine injuries and low back pain. Our study was conducted at the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine involving 40 athletes consisting of 28 males and 12 females. Single blinding was used and participants were divided into an intervention (wet cupping) and a sham group. Our findings showed significant reduction in pain intensity scores from the pre-intervention (7.2 ± 1.5) to post-intervention (4.5 ± 1.2), suggesting a positive effect of wet cupping therapy on cervical spine injuries (Mean Difference [MD] = -2.7 ± 1.3, p = 0.001). Statistically significant increase in functional improvements in the intervention group from pre-intervention (28.3 ± 4.0) to post-intervention (18.9 ± 3.5) due to the wet cupping therapy (MD = -9.4 ± 2.1, p = 0.021). Significant improvements in the range of motion assessed from cervical flexion, cervical extension, cervical lateral flexion, and cervical rotation. Sleep quality based on Pittsburgh Sleep Quality Index (PSQI) scores exhibited a mean difference of -1.4 ± 1.2 which was statistically significant (p = 0.001). Muscle strength of Neck Flexors, Neck Extensors, Upper Trapezius, Rhomboids, Cervical Rotators, Deltoids and Biceps were significantly while minimal adverse outcomes were observed in the intervention group. In conclusion, the application of wet cupping therapy could be an effective treatment for alleviating pain, improving muscle strength, quality of life, range of motion, functional improvements and reducing adverse outcomes in athletes with cervical spine injuries (AU)

Diagnosis and treatment of cervical spine injuries in children.

Cervical spine injuries in children are a common reason for emergency room visits, while bone, ligament or spinal cord cervical lesions are relatively rare (1-1.5% of severe trauma in children) and mainly involve the upper cervical spine. The main causes are sports injuries, accidents at home and traffic accidents. Clinical triage is needed to avoid unnecessary radiation exposure from imaging. We propose a protocol to optimize the diagnosis and treatment. In children, conservative treatment using rigid immobilization (cervical collar or halo-vest) is the preferred option in stable and/or minimally displaced injuries. Frequent clinical and radiological monitoring is required to ensure the patient's condition does not deteriorate due to inappropriate or poorly tolerated treatment. In these cases, surgical treatment can be proposed as second-line treatment. Internal fixation is indicated as the first-line treatment if the injury is unstable or a neurological deficit is present. The fixation methods must be adapted to the pediatric population by taking into account the vertebral volume and residual growth potential. Intraoperative CT scans or neuronavigation can make the surgical procedure safer and easier. Clinical, radiographic and CT scan monitoring should continue until the end of growth in a child who underwent surgical treatment to quickly detect any mechanical complications or sagittal imbalance due to poor craniocervical or cervicothoracic alignment. LEVEL OF EVIDENCE: IV.

Emergency Treatment of Cervical Vertebromedullary Trauma: 10 Years of Experience and Outcome Evaluation.

OBJECTIVE: The aim of the study is to identify and validate, through the recording of clinical and radiological data, the different surgical approaches and treatments valid for most subaxial cervical dislocation fractures and whether there is an advantage from using an anterior approach rather than a posterior approach and conversely.. MATERIAL AND METHODS: A retrospective study was carried out analyzing the case history of the last 10 years of vertebromedullary traumas treated at the spine surgery unit of the Policlinico Gemelli in Rome. Data on surgical timing, American Spinal Injury Association (ASIA) scores for neurological damage, and subsequent assessments on recovery, survival, and mortality were also examined. RESULTS: A total of 80 patients were treated: 50 by the posterior approach, 24 by the anterior approach, and six by the double approach. Our average follow-up time was 4.2 years. A prevalence of surgery with the posterior approach was noted. We observed the worsening of cervical kyphosis about 15 months after the trauma in two cases treated with the posterior approach alone. A second surgical treatment was performed in these patients. One of these patients underwent an anterior fusion; the other case underwent a posterior revision because the patient had ankylosing spondylitis. Although we found no statistically significant difference in outcomes between the various surgical treatments, in this retrospective study, we analyzed the characteristics and outcomes of cervical spine injuries that required surgical treatment. CONCLUSION: The aim of surgery in unstable cervical spine injuries should be to reduce and stabilize the damaged segment, maintain lordosis, and decompress when indicated. The optimal choice of surgical approach and treatment, or its superiority in terms of outcomes, remains a debated issue.

Lumbar Spine Injury in Indian Fast Bowlers: 3D Biomechanical Analysis and Prevention Strategies.

Background: Lumbar spine injuries are among the most common overuse injuries in a fast bowler. Among various causative factors, bowling action technique is a crucial one. Three-dimensional motion analysis has been accepted as a gold standard tool to identify incorrect techniques. Previous studies have identified key biomechanical variables associated with lumbar injury risk in fast bowlers. Despite the large popularity of the sport, there is limited information available on the subject in Indian fast bowlers. This study aims to analyse the lumbar spine injury risk in Indian fast bowlers with respect to key biomechanical variables, using 3D motion analysis. Methods: Forty-seven male first class fast bowlers underwent 3D motion analysis in an indoor biomechanics laboratory. Motion capture was done with 3D cameras and 2D video cameras, using a standard marker set. Data processing and analysis was done using proprietary software. Biomechanical variables associated with lumbar spine injury risk including lateral trunk flexion (LTF) and knee angle at front foot contact (KA at FFC) were measured, and peak vertical ground reaction forces (pVGRF) were simultaneously recorded using force plates. Descriptive analysis of the data was done. Results: 26% of bowlers had a high LTF, 29% had low KA at FFC and 43% had high pVGRF. Thus, a large proportion of bowlers in this study were at risk of lumbar spine injury with respect to the assessed variables. Conclusion: This highlights the role of 3D motion analysis in early identification of injurious techniques, which can be modified by coaching and training interventions to prevent injuries. This study thus has implications on coaching and training of fast bowlers in India.

Spine Injuries in Household Environments: A Comprehensive Analysis.

Introduction Recognizing the concerns posed by spine injuries within homes, stemming from falls, interactions with furnishings, and daily activities, it is imperative to consider preventive strategies. Our analysis of spine injuries utilizing the National Electronic Injury Surveillance System (NEISS) data sheds light on falls, furnishings, age-specific risks, recreation, technology, and socioeconomic disparities as contributing elements, accentuating the need for targeted interventions. This study aims to provide insights into the prevalence of spine injuries in different household locations, associated products, age groups, and gender, thus informing injury prevention strategies for safer living environments. Methods This is a retrospective, cross-sectional study utilizing data between 2013 to 2022 from the National Electronic Injury Surveillance System database. Specific household product codes and demographic data, such as age and gender, were analyzed. Statistical analysis in R (R Foundation for Statistical Computing, Vienna, Austria) involved descriptive statistics and multivariate logistic regressions. Results In analyzing 44,267 spine injuries, the study revealed location-specific variations in spine injuries within households. Living rooms and bedrooms had the highest injury rates at 34.17% and 21.65%, respectively. Significant differences in injury rates between males and females across various home locations. Females accounted for 51.78% of injuries in the living room and 59.99% in the bedroom. In the kitchen, females experienced 53.21% of injuries, while males accounted for 46.79% of cases. Notably, overall spine injuries exhibited a significant difference between males and females, with females having a higher total likelihood of injuries (AOR = 1.21, 95% CI: 1.14-1.77, p < 0.001). Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, accounting for 17.98% of total cases. Notably, the age group of 61-70 years exhibited a substantial proportion of injuries at 17.12%, while the age group of 71-80 years accounted for 14.39%. The age group of 41-50 years also displayed a notable injury rate of 14.12%. The youngest age group, 0-10 years, demonstrated the lowest percentage of injuries at 4.79%. This age-based analysis provides valuable insights into the distribution of spine injuries across different demographic segments. Regarding age, individuals between 51-60 years were most vulnerable to spine injuries, comprising 17.98% of total cases. Age groups of 41-50 and 61-70 years also showed substantial proportions of injuries, accounting for 14.12% and 17.12%, respectively. The youngest age group, 0-10, exhibited the lowest percentage of injuries at 4.79%. Conclusion The study focuses on the occurrence of spinal injuries in common sites of injury in the household, such as the living room, bedroom, kitchen, and stairs. There is increased prevalence amongst females and increased risk vulnerability amongst people 51 to 60 years of age. Our research emphasizes the necessity of implementing specific injury prevention measures tailored to different demographic groups within their home setting. This approach should involve collaborative decision-making with patients while prioritizing patient education to create a safer living environment and reduce the likelihood of spine injuries.

Anterior Screw Fixation for Odontoid Fractures - A Case Series.

Introduction: Fractures of the odontoid process are common cervical spine injuries, accounting for 10-20% of all cervical spine fractures. Anterior screw fixation of odontoid fractures is an osteosynthetic technique that can give immediate stability and preserve normal mobility. Case Series: The study was conducted in Government Mohan Kumaramangalam Medical college in the period 2017-2020. Five patients with Anderson and D'Alonzo type II odontoid Fractures were included in the study. Through anterior approach, using a horizontal skin incision, a K wire is inserted from the inferior edge of C2 through the incision and impacted into the odontoid process. A cannulated screw with non-threaded proximal shaft is inserted and tightened firmly to allow the distal fragment to compress on the body of C2. All the patients were reviewed postoperatively at 3, 6, and 12 months. Out of the five patients, all the patients had successful anatomical union at the end of 16 weeks. No neurological sequelae were reported. Discussion: Anterior screw fixation provides a reasonable approach to odontoid fractures. Posterior stabilization using multiple techniques has been described with good union rates but has several disadvantages. Anterior screw fixation provides direct fracture fixation without the need for bone grafts. In addition, it reduces post-operative discomfort and length of hospital stay. Conclusion: Anterior odontoid screw fixation was associated with relatively low complication rates and a high union rate in our study. We conclude that this shall be the preferred treatment method for Type II odontoid fractures.

Posterior Temporary C1-2 Pedicle Screws Fixation for the Treatment of Unstable C1-2 Complex Fractures: Minimum of 2-Year Follow-Up.

STUDY DESIGN: Retrospective. OBJECTIVES: To present rarely reported complex fractures of the upper cervical spine (C1-C2) and discuss the clinical results of the posterior temporary C1-2 pedicle screws fixation for C1-C2 stabilization. METHODS: A total of 19 patients were included in the study (18 males and 1 female). Their age ranged from 23 to 66 years (mean age of 39.6 years). The patients were diagnosed with complex fractures of the atlas and the axis of the upper cervical spine and underwent posterior temporary C1-2 pedicle screws fixation. The patients underwent a serial postoperative clinical examination at approximately 3, 6, 9 months, and annually thereafter. The neck disability index (NDI) and the range of neck rotary motion were used to evaluate the postoperative clinical efficacy of the patients. RESULTS: The average operation time and blood loss were 110 ± 25 min and 50 ± 12 ml, respectively. The mean follow-up was 38 ± 11 months (range 22 to 60 months). The neck rotary motion before removal, immediately after removal, and the last follow-up were 68.7 ± 7.1°, 115.1 ± 11.7°, and 149.3 ± 8.9° (P < 0.01). The NDI scores before and after the operation were 42.7 ± 4.3, 11.1 ± 4.0 (P < 0.01), and the NDI score 2 days after the internal fixation was removed was 7.3 ± 2.9, which was better than immediately after the operation (P < 0.01), and 2 years after the internal fixation was removed. The NDI score was 2.0 ± 0.8, which was significantly better than 2 days after the internal fixation was taken out (P < 0.001). CONCLUSIONS: Posterior temporary screw fixation is a good alternative surgical treatment for unstable C1-C2 complex fractures.

Pathoanatomy, biomechanics, and treatment of upper cervical ligamentous instability: A literature review.

Background: Cervical spine instability broadly refers to compromise of the articular congruity. It can be stratified according to spinal level, functional compromise, and mechanism of instability. Conventional wisdom advocates for use of bracing and physical therapy with only a subset of patients proceeding to obtain surgical treatment. Objective: The purpose of this review article is to summarize the current state of knowledge on upper cervical ligamentous instability. Methods: The literature search was performed in Mendeley. Search fields were varied until redundant. All articles were screened by title and abstract and a preliminary decision to include an article was made. The full-text screening was performed on the selected articles. Any question regarding the inclusion of an article was discussed by 3 authors until an agreement was reached. Results: Many articles report on the etiological factors including ligamentous laxity, traumatic injury, syndrome instability, iatrogenic instability, congenital, and inflammatory causes. A few recent studies elucidate new findings regarding pathoanatomy through the use of finite element analysis. A few articles demonstrate the diagnosis and show that radiographs alone have a low diagnostic rate and that functional MRI may be able to better quantify instability. Conservative treatment has been described, but there are no outcome studies in the literature. Surgical treatment has been described in many different populations with good radiologic and clinical outcomes. Recently the use of preoperative 3D CT reconstruction has been described with radiographic and immediate postoperative patient-reported outcomes. Conclusion: The presentation of upper cervical spinal instability can be asymptomatic, symptoms of isolated instability, symptoms of nerve irritation, vertebrobasilar insufficiency, or severe neurologic compromise. 3D fine element analysis models and motion-capture systems have the potential to increase our understanding of the pathoanatomic cascade in both traumatic and non-traumatic cases of upper cervical spinal instability. A few modalities on the horizon could increase diagnostic potential. More efforts are needed regarding the use of fine element analysis in understanding the pathoanatomic cascade, the long-term outcomes of children over a spectrum of syndromic causes, and the potential of preoperative virtual simulation to improve surgical outcomes.

Imaging of thoracolumbar spine traumas.

Spine trauma is an ominous event with a high morbidity, frequent mortality, and significant psychological, social, and financial consequences for patients, their relatives and society. On average three out of four spinal fractures involve the thoracolumbar spine and up to one-third are complicated by spinal cord injury. Spinal cord injuries (SCI) are a significant cause of disability in US and in all western countries. Knowledge of the main principles of biomechanics is essential in understanding the patho-morphology of spinal injuries, and the evolution of the various classification systems. Classification systems should be able to create a common language between specialists in order to improve patients' prognosis, guide treatment and compare treatment outcomes. Imaging has always been crucial in the evaluation of the injury type and accompanied the development of different classification systems. Thoracolumbar spine (TLS) trauma has a wide spectrum ranging from minor isolated fractures to highly unstable fracture-dislocations. Early classification systems were based on the analysis of the pattern of bony injuries on radiographs and CT. Traditionally, conventional radiographs are performed to confirm the clinical suspicion and to depict the level and type of bone injury. However, because of their inherent limitations, radiographs are often more helpful in proving the existence of a suspected bony spinal injury rather than excluding it. Multidetector computed tomography (MDCT) is superior in evaluating bone anatomy and, especially in polytrauma patients, it is the first line imaging modality. Morphological bone damage may be accurately shown and classified on CT. the most recent classifications also incorporate the integrity of soft tissues structures, which is considered equally relevant to spinal stability. Injuries to ligaments and discs can only be suspected on radiographs and conventional CT, although dual-energy CT is offering new insights on collagen mapping of damaged discs. Magnetic resonance imaging (MRI) may directly assess disc and ligamentous injuries, but also subtle osseous injuries, playing a complementary role in defining the whole spinal damage and an eventual instability. MRI is the only valid modality to assess the spinal cord (SC) and is indicated whenever a neurologic injury is suspected. Advanced MRI techniques, such as diffusion weighted imaging (DWI) and tractography, may provide further information regarding the integrity of the white matter which may improve outcome prognostication. Despite challenges in terms of costs, availability, accessibility and specificity, MRI and advanced MRI techniques are increasingly being used in spinal injuries. We present a review on TLS traumas discussing on the development of different classification system used in their evaluation, the role of imaging for their detection and the correlation to the patients' outcomes and treatment options.

Quantitative cervical spine injury responses in whiplash loading with a numerical method of natural neural reflex consideration.

BACKGROUND AND OBJECTIVE: Neural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite element analysis of head-neck system for various applications. The purpose of this study is to investigate the influences of neural reflex control on neck biomechanical responses, then provide a new way to achieve an accurate biomechanical analysis for head-neck system with a finite element model. METHODS: A new FE head-neck model with detailed active muscles and spinal cord modeling was established and globally validated at multi-levels. Then, it was coupled with our previously developed neuromuscular head-neck model to analyze the effects of vestibular and proprioceptive reflexes on biomechanical responses of head-neck system in a typical spinal injury loading condition (whiplash). The obtained effects were further analyzed by comparing a review of epidemiologic data on cervical spine injury situations. RESULT: The results showed that the active model (AM) with neural reflex control obviously presented both rational head-neck kinematics and tissue injury risk referring to the previous experimental and epidemiologic studies, when compared with the passive model (PM) without it. Tissue load concentration locations as well as stress/strain levels were both changed due to the muscle activation forces caused by neural reflex control during the whole loading process. For the bony structures, the AM showed a peak stress level accounting for only about 25% of the PM. For the discs, the stress concentrated location was transferred from C2-C6 in the PM to C4-C6 in the AM. For the spinal cord, the strain concentrated locations were transferred from C1 segment to around C4 segment when the effects of neural reflex control were implemented, while the gray matter and white matter peak strains were reduced to 1/3 and 1/2 of the PM, respectively. All these were well correlated with epidemiological studies on clinical cervical spine injuries. CONCLUSION: In summary, the present work demonstrated necessity of considering neural reflex in FE analysis of a head-neck system as well as our model biofidelity. Overall results also verified the previous hypothesis and further quantitatively indicated that the muscle activation caused by neural reflex is providing a protection for the neck in impact loading by decreasing the strain level and changing the possible injury to lower spinal cord level to reduce injury severity.

Utilization of computerized tomography and magnetic resonance imaging for diagnosis of traumatic C-Spine injuries at a level 1 trauma center: A retrospective Cohort analysis.

BACKGROUND: Computerized tomography (CT) is a common imaging modality for trauma patients, but there is debate regarding the role of magnetic resonance imaging (MRI) in cervical (C)-spine clearance. We aim to investigate the utilization of CT and MRI imaging in traumatic C-spine clearance and associated outcomes on patients who undergo both imaging modalities. METHODS: A 4-year retrospective review was performed to evaluate the trauma patient imaging algorithm at our institution. The algorithm required CT as a screening examination for traumatic injury patients who are unexaminable because of distracting injury, altered mental status, an abnormal neurological examination, and/or central neck pain. MRI was performed after CT in patients with C-spine injuries identified on CT, those who remained unexaminable, had an abnormal neurological examination, or experienced persistent central neck tenderness. Univariate analyses and adjusted multivariate logistic regression were performed with significance defined as p < 0.05. RESULTS: 805 patients were analyzed. Compared to MRI, CT had a sensitivity of 50.2%, specificity of 76.6%, positive predictive value of 69.7%, and negative predictive value of 59.0% in detecting C-spine injuries. CT and MRI differed significantly in their ability to detect C-spine soft tissue injuries and C1 vertebral fractures (p < 0.05). CONCLUSIONS: MRI is more capable of detecting soft tissue injuries whereas CT is superior in detecting vertebral fractures. Our findings support the need to utilize CT and MRI in conjunction to detect both bony and soft tissue C-spine injuries in traumatically injured patients, who are either unexaminable, have an abnormal neurologic examination, or ongoing central neck tenderness.

Neck Trauma: Cervical Spine, Seatbelt Sign, and Penetrating Palate Injuries.

Pediatric cervical spine, blunt cerebrovascular, and penetrating palate injuries are rare but potentially life-threatening injuries that demand immediate stabilization and treatment. Balancing the risk of a missed injury with radiation exposure and the need for sedation is critical in evaluating children for these injuries. Unfortunately, effective clinical decision tools used in adult trauma cannot be uniformly applied to children. Careful risk stratification based on history, mechanism and examination is imperative to evaluate these injuries judiciously in the pediatric population. This article presents a review of the most up-to-date literature on pediatric neck trauma.

Implementation of a dual cervical spine and blunt cerebrovascular injury assessment pathway for pediatric trauma patients.

BACKGROUND: Pediatric cervical spine (CSI) and blunt cerebrovascular injuries (BCVI) are challenging to evaluate as they are rare but carry high morbidity and mortality. CT scans are the traditional imaging modality to evaluate for CSI/BCVI, but involve radiation exposure and potential future increased risk of malignancy. Therefore, we present results from the implementation of a combined CSI/BCVI pediatric trauma clinical pathway to aid clinicians in their decision-making. METHODS: We conducted a 2-year retrospective cohort study analyzing data pre and post implementation of the combined CSI/BCVI pathway. Data was obtained from a level 1 pediatric trauma center and included blunt trauma patients under the age of 14. We evaluated the use of cervical spine computed tomography (CT), CT angiography, and plain radiographs, as well as missed injuries and provider pathway adherence. RESULTS: We included 358 patients: 209 pre-pathway and 149 post-pathway implementation. Patient mean age was 8.9 years and 61% were male (61% males). There were no significant differences in GCS, AIS, and ISS between pre and post pathway groups. Post pathway implementation saw reduced use of cervical spine CT, although this was not clinically significant (33% vs 31%, p = 0.74). However, cervical spine radiography use increased (9% vs 16%, p = 0.03), and there was also an increase in screening for BCVI injuries with higher use of CTA (5% vs 7%, p = 0.52). A total of 12 CSI and 3 BCVI were identified with no missed injuries. Provider adherence to the pathway was modest (54%). Conclusion Implementation of a combined CSI/BCVI clinical pathway for pediatric trauma patients increased screening radiography and did not miss any injuries. However, CT use did not significantly decrease and provider adherence was modest, supporting the need for further implementation analysis and larger studies to validate the pathway's sensitivity and specificity for CSI/BCVI.

Prevalence of Neurologic Deficits in Combined Facial and Cervical Spine Injuries: A Retrospective Analysis.

STUDY DESIGN: A retrospective data analysis of maxillofacial trauma patients with combined cervical spine injuries. OBJECTIVE: This study is based on investigating the importance of timely diagnosis of patients who suffer with cervical spine injuries along with maxillofacial trauma by estimating the prevalence of neurologic deficits and its relation with etiology. METHODS: A database of 4460 patients suffering from maxillofacial injuries and admitted in specialized environment surgery of Government Medical College, Trivandrum, Kerala was taken under consideration. The prevalence and types of neurologic deficits and its relation with etiology were assessed in patients with combined facial and cervical spine injuries. RESULTS: Of 4460 patients, 48 were having cervical spine injury along with facial damage with the prevalence of 0.01%. Neurologic deficits were seen highest with etiology of road traffic accidents followed by falls from height. Most of the accidents occurred in bike riders and helmets were absent. CONCLUSIONS: It was concluded that most of the accidents engage bike riders and drivers, due to unethical and unsafe driving. There was no significant correlation found between facial and cervical spine injuries.

Treatment strategies for managing cervical spine injuries in rugby players.

BACKGROUND: Cervical spine fractures are potentially catastrophic injuries in rugby players. Here, we reviewed seven patients who sustained rugby-related cervical spine fractures. Notably, three of seven fractures were missed on initial X-rays, but were ultimately documented on CT studies obtained an average of 10 days later. METHODS: Seven patients sustained cervical spine fracture attributed to rugby (2009-2016) and were followed an average of 52 posttrauma months. Most injuries occurred at the C6-C7 level, and six of seven patients required surgery. Further, only two of seven patients exhibited resultant neurological deficits (e.g., one myelopathy and one radiculopathy). RESULTS: Although the rugby injury was sufficiently documented on initial X-rays in four patients, three initial X-rays missed fractures, which were documented on the CT studies obtained an average of 10 days later. CONCLUSION: Rugby-related cervical fractures must be considered where players continue to complain of pain following trauma. Notably, routine X-rays may miss fractures in 3 of 7 cases (43%), thus warranting supplemental CT examinations to definitively rule out fractures.

A profile of traumatic brain injuries and associated cervical spine injuries at a regional hospital in the KwaZulu-Natal Province.

BACKGROUND: Clearing the cervical spine in an unconscious blunt trauma patient is an elusive concept. The aim of this study was to describe the incidence of cervical spine injury (CSI) in patients with a traumatic brain injury (TBI). The study was conducted on patients who underwent imaging of both the cervical spine and the brain in one sitting at a busy government healthcare facility in Pietermaritzburg. METHODS: This was a retrospective, cross sectional study of all the trauma patients presenting to a regional hospital emergency department (ED) in the KwaZulu-Natal (KZN) Province, who underwent computed tomography (CT) imaging of the brain and the cervical spine in one sitting during the period January 2016 to June 2016. RESULTS: Adult males formed the majority (78.9%) of the study population and had the highest incidence of TBI, the most common identified pathology in CT being parenchymal injuries (41%). The mechanisms that resulted in the majority of injuries sustained were assault (38.7%) and motor vehicle collisions (MVCs) (25%), while seven patients (4.76%) had a combined diagnosis of TBI and CSI. The average Glasgow Coma Scale (GCS) was 12. CONCLUSION: Young adult males are at the greatest risk of sustaining TBI, with assault being the most common mechanism of injury. Combined diagnoses of TBI and CSI are rare and were mostly noted in patients involved in MVCs and pedestrian vehicle collisions. While the chance of an abnormal CT scan increased with a decreasing GCS score, 33% of patients with a mild TBI did not have abnormal CT findings, and 25% patients with severe TBI had no abnormal CT findings.