Approximately two thirds of cervical spine injuries occur within the subaxial cervical spine, with fractures occurring most often at C6 and C7 and dislocations occurring most commonly between C5-C6 and C6-C7 1).
The age factor modulates human cervical spine tolerance to impact injury 7).
Cervical spine injury classification systems should be simple, easy to relate and remember, reliable guide for surgical planning, and predictor of outcome in clinical settings.
A missed cervical spine (CS) injury can have devastating consequences. When CS injuries cannot be ruled out clinically using the National Emergency X-Radiography Utilization Study low-risk criteria because of either a neurologic deficit or pain, the optimal imaging modality for CS clearance remains controversial.
The initial evaluation of patients for cervical spine injury involves a detailed physical examination with careful evaluation of the criteria to determine whether radiographic evaluation of the cervical spine is necessary.
Once screening the cervical spine with radiography has been determined necessary, plain radiography has traditionally been the initial screening test for patients at risk of cervical spine injury.
Realization that standard cervical spine radiography fails to identify all patients with cervical spine injuries has resulted in the use of additional radiographic studies including supine oblique views, flexion-extension radiographs, or computed tomography (CT) scanning.
Computed tomography is effective in the detection of clinically significant CS injuries in adults deemed eligible for evaluation who had a neurologic deficit or CS pain.
Is being utilized with increasing frequency as a screening test for patients with potential cervical spine injury. However, the appropriate screening test to rule out cervical spine injury in the blunt trauma patient is unclear.
For Resnick et al., magnetic resonance imaging does not provide any additional clinically relevant information 8).
The neurosurgical evaluation and management of athletes after cervical spine injury with T2 hyperintensity on MRI is challenging. Although the presence of T2 hyperintensity is evidence of spinal cord trauma, the long-term prognostic value on an athlete’s career and return-to-play (RTP) recommendations of this finding are poorly understood.
Much of the literature on cervical cord T2 hyperintensity relates to degenerative spine conditions. For example, several studies have examined the evolution of intramedullary T2 hyperintensity after ventral decompressive surgery for cervical spondylotic myelopathy (CSM) 9) 10).
In 2013 the American Association of Neurological Surgeons and the Congress of Neurological Surgeons released updated management guidelines for the acute cervical spine injury and spinal cord injury SCI.
Of 56 studies published in the Cochrane Library Central Register of Controlled Trials, 19 met inclusion criterion of acute cervical spine injury and are summarized across 4 subcategories: diagnosis, surgical stabilization, scopes/instrumentation, and therapeutic outcomes. Yup et al. confirm the utility of computed tomography for diagnosis, and improved outcomes associated with early (<24h) decompressive surgery. They describe advances in laryngoscopy and intubation under various SCI indications. They explore the benefits of continuous positive airway pressure protocols for reducing respiratory insufficiency, and patient education standards for transfer and mobility success. They report on ongoing randomized controlled trials (RCT) for surgical and therapeutic approaches for subpopulations of interest, including incomplete cord lesion, canal stenosis, and riluzole pharmacotherapy. They recommend a large, multicenter, prospective confirmatory RCT to assess the impact of timing of surgery versus conservative management in an effort to generate Class I evidence on the topic. Such a study should utilize shared, common variables as outlined by the National Institutes of Health SCI Common Data Elements to enable international collaboration and data pooling for robust, reproducible analyses 11).
If a patient arrives with an intact neurologic examination despite gunshot wound or stab wounds to the neck, the incidence of a cervical spine injury that requires a therapeutic intervention is minute. As a result, in a neurologically intact and examinable patient, a cervical collar should be immediately removed to facilitate the remaining components of the diagnostic evaluation 12).
The cervical spine injury represents a potential devastating disease with 6% associated in-hospital mortality.
Cervical spine injury complicates the care of approximately 4% of injured patients admitted to trauma centers across the United States.