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Cervical Spine Trauma S13.4XXA

Lower extremity Cutaneous Innervation

Glasgow Coma Scale

Spinal Cord Anatomy

Upper Extremity innervation

Upper Extremity Sensory innvervation

synonyms: cervical spine trauma, 

Cervical Spine Trauma ICD-10

Cervical Spine Trauma Etiology / Epidemiology / Natural History

  • Typically high energy trauma
  • Associated the American Football, spear tackling. 

Cervical Spine Trauma Anatomy

Cervical Spine Trauma Clinical Evaluation

  • Palpate entire spine for tenderness / step off.
  • Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
  • Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
  • See ASIA form.

Cervical Spine Trauma Xray / Diagnositc Tests

  • Lateral c-spine generally taken as part of ATLS for patients who are unstable.
  • A/P, Lateral, Odontoid, views indicated for high risk patients: (1)older than 65y/o, (2)paresthesias in the extremities, (3) dangerous injury mechansim. Imaging is not required in low-risk patients who ccan activtely rotate the neck 45° to the right and left. Low-risk:(1)simple rear end collision, able to maintain sitting position, (3)ambulatory, (4) delayed onset neck pain, (5)absence of midline c-spine tenderness. (Stiell IG, JAMA 2001;286:1841).
  • CT cervical spine: indicated for obtunded patients before c-spine clearance. Better cost-effectivness, sensitiivty and safety than screening xrays, but exposes patients to 6x more radiaiton.
  • MRI: indicated for neuro deficit, suspicious of instability or HNP, pre-op evaluation

Cervical Spine Trauma Classification / Treatment

  • Any trauma pt with suspected C-spine injury should be immobilized on a spine board with cervical collar and log-roll precautions until the c-spine has been cleared.
  • Protective equipement such as the helmet and shoulder pads should be left in place.  Removal risks progressive neurologic injury from a potentially unstable cervical spine injury. Removal of the face mask alone is typically performed allow airway access.
  • C-spine Fracture/dislocatio, closed reduction in awake, cooperative patient: closed reduction with Gardner-Wells tongs/traction with serial neuro exams and xrays.
  • See Differential Diagnosis for specific injuries / treatments.

Cervical Spine Trauma Differential Diagnosis

  • Occipital Condyle Fracture
  • Occipitocervical Dissociation
  • Atlas fracture
  • C2 fracture
  • Odontoid fracture
  • Facet Dislocation
  • Facet Fracture
  • Burst Fracture
  • Compression Fracture
  • Teardrop Fractures
  • Spinal Cord Injury

Cervical Spine Trauma Complications

Cervical Spine Trauma Follow-up Care

Cervical Spine Trauma Review References

  • Boden BP, Tacchetti RL, Cantu RC, Knowles SB, Mueller FO. Catastrophic cervical spine injuries in high school and college football players. Am J Sports Med. 2006 Aug;34(8):1223-32.
  • Mall NA, Buchowski J, Zebala L, Brophy RH, Wright RW, Matava MJ. Spine and axial skeleton injuries in the National Football League. Am J Sports Med. 2012 Aug;40(8):1755-61.
  • Rihn JA, Anderson DT, Lamb K, Deluca PF, Bata A, Marchetto PA, Neves N,Vaccaro AR. Cervical spine injuries in American football. Sports Med. 2009;39(9):697-708. 
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