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Cervical Spine Fracture

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81. AIM Clinical Appropriateness Guidelines for Spine Surgery

Health. All Rights Reserved. Spine Surgery 7 Criteria Cervical decompression with or without fusion may be indicated to treat any of the following conditions: Instability of the cervical spine due to any of the following conditions, where instability is caused by the condition itself, or when treatment of the condition is anticipated to result in instability (i.e., resection or debridement) ? Tumor of the spine or spinal canal ? Infection (osteomyelitis, discitis, or spinal abscess) ? Fracture (...) AIM Clinical Appropriateness Guidelines for Spine Surgery Appropriate.Safe.Affordable © 2019 AIM Specialty Health 2063-0119 V.3 Spine Surgery Guidelines Musculoskeletal Program Clinical Appropriateness Guidelines Spine Surgery EFFECTIVE JANUARY 01, 2019 LAST REVIEWED SEPTEMBER 12, 2018 Copyright © 2019. AIM Specialty Health. All Rights Reserved. Spine Surgery 2 Table of Contents Spine Surgery Guidelines 1 Description and Application of the Guidelines 4 Cervical Decompression With or Without

2019 AIM Specialty Health

82. Spine imaging

worsening pain following an injury ? Suspected fracture or craniocervical instability when radiographs are nondiagnostic IMAGING STUDY - CT or MRI cervical spine Rationale Multiple guidelines recommend use of CT in patients with acute significant cervical trauma. 25, 26 While the diagnostic yield in the acute trauma setting is low, 27 the morbidity and mortality of a missed fracture are high. 28 After initial evaluation with CT, MRI may be a helpful add-on test in select patient populations (...) Infectious and Inflammatory Conditions 12 Juvenile idiopathic arthritis (Pediatric only) 12 Multiple sclerosis or other white matter disease 12 Rheumatoid arthritis (Adult only) 12 Spinal infection 13 Spondyloarthropathy 13 Trauma 14 Cervical injury 14 Thoracic or lumbar injury 14 Tumor 15 Tumor 15 Miscellaneous Conditions of the Spine 15 Osteoporosis and osteopenia 15 Spinal cord infarction 16 Spondylolysis and spondylolisthesis 16 Syringomyelia 16 Signs and Symptoms 16 Cauda equina syndrome 16

2019 AIM Specialty Health

83. Suspected Spine Trauma ? Child

<8 years of age and mostly affects the cervical spine, but thoracic spine involvement is seen in 13% of cases [93]. It has been reported that SCIWORA was found in up to 38% of pediatric patients with myelopathy and no fracture or ACR Appropriateness Criteria ® 10 Suspected Spine Trauma–Child ligamentous injury on radiographs or CT [91]. In adults with SCIWORA, MRI screening did not yield positive findings in a substantial number of patients [98], but examinations in children were able to diagnose (...) AS, Prevedello DM, Shaffrey CI, Jane JA, Jr. Cervical spine injuries in pediatric athletes: mechanisms and management. Neurosurg Focus 2006;21:E6. 21. Huber AM, Gaboury I, Cabral DA, et al. Prevalent vertebral fractures among children initiating glucocorticoid therapy for the treatment of rheumatic disorders. Arthritis Care Res (Hoboken) 2010;62:516-26. 22. Rodd C, Lang B, Ramsay T, et al. Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation

2019 American College of Radiology

84. ACR–ASNR–ASSR–SPR Practice Parameter for the Performance of Computed Tomography (CT) of the Spine

in and is considered a primary imaging evaluation of acute spine trauma in adults. CT can be used for evaluating vertebral compression/insufficiency fractures in both acute and chronic clinical situations [1-14] 2. Given that the vast majority of cervical spine injuries in young children (especially those <3 years old) are of soft tissue rather than bone and considering the special vulnerability of this patient population to radiation, it should be recognized that the use of CT in this population may be of limited (...) characterization of burst fractures of the spine. AJR Am J Roentgenol. 1986;147(3):575-582. 2. Barba CA, Taggert J, Morgan AS, et al. A new cervical spine clearance protocol using computed tomography. J Trauma. 2001;51(4):652-656; discussion 656-657. 3. Blackmore CC, Ramsey SD, Mann FA, Deyo RA. Cervical spine screening with CT in trauma patients: a cost-effectiveness analysis. Radiology. 1999;212(1):117-125. 4. Cornelius RS, Leach JL. Imaging evaluation of cervical spine trauma. Neuroimaging Clin N Am. 1995;5

2019 American Society of Neuroradiology

85. ACR–ASNR–SCBT-MR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Adult Spine

, and combined CT-myelography. Compared with these other modalities, MRI does not use ionizing radiation. This is particularly advantageous in the lumbar area, where gonadal exposure may occur, and in the cervical spine to avoid radiation to the thyroid. Myelography requires an invasive procedure to introduce intrathecal contrast agents. Both the puncture and the contrast agent can produce side effects and rarely significant adverse reactions. MRI allows direct visualization of the spinal cord, nerve roots (...) , including abscess 4. Vascular disorders a. Spinal vascular malformations and/or the cause of occult subarachnoid hemorrhage b. Spinal cord infarction c. Extraspinal vascular malformations and neoplasms PRACTICE PARAMETER 3 MRI Adult Spine 5. Degenerative conditions a. Degenerative disc disease and its sequelae in the lumbar, thoracic, and cervical spine, including myelopathy b. Disc herniation and radiculopathy c. Neurodegenerative disorders, such as subacute combined degeneration, spinal muscular

2019 American Society of Neuroradiology

86. Cervical spine assessment following trauma

injury is more common in patients with multiple injuries, isolated injury may occur following comparatively minor traumatic incidents. 1 A recent meta-analysis of 65 studies including almost 282 000 trauma patients, found that cervical spine injury occurs in 3.7% of patients overall, with 2.8% of alert patients and 7.7% of obtunded patients having an acute abnormality detected. Of the patients with cervical spine injury identified, 42% were found to have fracture, dislocation or pure discoligamentous (...) , particularly when cervical spondylosis is present. 1,3 Potential serious injuries include vertebral body fracture, disc extrusion, cord contusion or compression, ligamentous rupture, epidural haematoma, facet displacement and vertebral or carotid arterial injury. The presence of cervical spine injury is often overt, indicated by neurologic deficit or radiographically demonstrated fracture or malalignment. Other more subtle injuries, such as occult cervical soft tissue disruption, or associated vertebral

2012 Clinical Practice Guidelines Portal

87. Femur fractures should not be considered distracting injuries for cervical spine assessment. (PubMed)

Femur fractures should not be considered distracting injuries for cervical spine assessment. The National Emergency X-Radiography Utilization Study (NEXUS) clinical decision rule is extremely sensitive for clearance of cervical spine (C-spine) injury in blunt trauma patients with distracting injuries.We sought to determine whether the NEXUS criteria would maintain sensitivity for blunt trauma patients when femur fractures were not considered a distracting injury and an absolute indication (...) for diagnostic imaging.We retrospectively analyzed blunt trauma patients with at least 1 femur fracture who presented to our emergency department as trauma activations from 2009 to 2011 and underwent C-spine injury evaluation. Presence of C-spine injury requiring surgical intervention was evaluated.Of 566 trauma patients included, 77 (13.6%) were younger than 18 years. Cervical spine injury was diagnosed in 53 (9.4%) of 566. A total of 241 patients (42.6%) had positive NEXUS findings in addition

2015 American Journal of Emergency Medicine

88. Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation in Cadavers-Cadavers versus Patients, the Effect of Repeated Intubations, and the Effect of Type II Odontoid Fracture on C1-C2 Motion. (PubMed)

Intubation Biomechanics: Laryngoscope Force and Cervical Spine Motion during Intubation in Cadavers-Cadavers versus Patients, the Effect of Repeated Intubations, and the Effect of Type II Odontoid Fracture on C1-C2 Motion. The aims of this study are to characterize (1) the cadaver intubation biomechanics, including the effect of repeated intubations, and (2) the relation between intubation force and the motion of an injured cervical segment.Fourteen cadavers were serially intubated using force (...) -sensing Macintosh and Airtraq laryngoscopes in random order, with simultaneous cervical spine motion recorded with lateral fluoroscopy. Motion of the C1-C2 segment was measured in the intact and injured state (type II odontoid fracture). Injured C1-C2 motion was proportionately corrected for changes in intubation forces that occurred with repeated intubations.Cadaver intubation biomechanics were comparable with those of patients in all parameters other than C2-C5 extension. In cadavers, intubation

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2015 Anesthesiology

89. Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center (PubMed)

Screening via CT angiogram after traumatic cervical spine fractures: narrowing imaging to improve cost effectiveness. Experience of a Level I trauma center Screening for vertebral artery injury (VAI) following cervical spine fractures is routinely performed across trauma centers in North America. From 2002 to 2007, the total number of neck CT angiography (CTA) studies performed in the Medicare population after trauma increased from 9796 to 115,021. In the era of cost-effective medical care (...) , the authors aimed to evaluate the utility of CTA screening in detecting VAI and reduce chances of posterior circulation strokes after traumatic cervical spine fractures.A retrospective review of all patients presenting with cervical spine fractures to Northeast Ohio's Level I trauma institution from 2002 to 2012 was performed.There was a total of 1717 cervical spine fractures in patients presenting to Northeast Ohio's Level I trauma institution between 2002 and 2012. CTA screening was performed in 732

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2015 Journal of neurosurgery. Spine

90. The influence of race and hospital environment on the care of patients with cervical spine fractures. (PubMed)

The influence of race and hospital environment on the care of patients with cervical spine fractures. The influence of non-white race on outcomes following orthopedic injury has been described in the past. The impact of such factors on hospital processes and quality of care after spinal trauma is less well understood.A cohort control study using the Massachusetts Statewide Inpatient Dataset (2003-2010) was used as the study design.This study aimed to determine whether (1) hospital processes (...) and quality of care associated with the treatment of cervical spine fractures was significantly altered by non-white race and (2) whether findings were different among those treated at academic medical centers (AMCs).The study comprised 10,841 patients.Surgical rate, postoperative morbidity, mortality, and length of stay (LOS) were the outcome measures.Baseline differences between cohorts were evaluated using chi-square or Wilcoxon rank sum tests. Logistic and negative binomial regression techniques were

2015 The Spine Journal

91. Surgical Therapy of Cervical Spine Fracture in Patients With Ankylosing Spondylitis. (PubMed)

Surgical Therapy of Cervical Spine Fracture in Patients With Ankylosing Spondylitis. The present study aimed to explore surgical treatments and assess the effects based on the features of cervical spine fracture in patients with ankylosing spondylitis (AS) and to summarize the experiences in perioperative management. Retrospective analysis was performed in 25 AS patients with cervical spine fracture treated in our hospital from January 2011 to December 2013. The patients were divided according (...) to fracture segments, including 4 cases at C4 to C5, 8 cases at C5 to C6, and 13 cases at C6 to C7. Among them, 12 belonged to I type, 5 to II type, and 8 to III type based on the improved classification method for AS cervical spine fracture. The Subaxial Cervical Spine Injury Classification score for these patients was 7.2 ± 1.3, and the assessment of their neurological function states showed 6 patients (24%) were in American Spinal Injury Association (ASIA) A grade, 1 (4%) in ASIA B grade, 3 (12

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2015 Medicine

92. Management of upper cervical spine fractures in elderly patients: current trends and outcomes. (PubMed)

Management of upper cervical spine fractures in elderly patients: current trends and outcomes. Upper cervical spine fractures in the elderly represent serious injuries. Their frequency is on the rise. Their early accurate diagnosis might be compromised by the existence of extensive degenerative changes and deformities. Adequate stabilisation allowing fracture healing is of paramount importance. However, the debate is ongoing as to the best protocol that can be applied taking into consideration (...) the presence of comorbidities and the increase risk of mortality in this frail patient population. A literature review, based on PubMed, related to protocols reporting on fracture fixation of the upper cervical spine, fractures (C1-C2) was carried out. Papers including information about type of fracture, treatment carried out, complication rates, mortality and morbidities were eligible to be included in this study. Fourteen papers met the inclusion criteria. Six reported on all types of injuries

2015 Injury

93. Changes in the care of patients with cervical spine fractures following health reform in Massachusetts. (PubMed)

Changes in the care of patients with cervical spine fractures following health reform in Massachusetts. There is a substantial concern among spine surgeons that healthcare reform efforts will alter the processes through which spinal care is delivered and decrease overall quality. We used the Statewide Inpatient Dataset for Massachusetts to evaluate changes in hospital processes and quality of care for patients with cervical fractures following the implementation of health reform.This was a pre (...) : 0.40, 0.89), a 30% decrease in surveillance insensitive complications (95% CI: 0.51, 0.96) and a 67% reduction in FTR after surveillance insensitive morbidity (95% CI: 0.11, 0.94).In the period following Massachusetts healthcare reform, significant improvements were noted in hospital process and quality measures around the care of patients with cervical spine fractures. Such findings were particularly robust among academic centers. These results may forecast changes in the delivery of spine

2015 Injury

94. Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study (PubMed)

Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting.The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI (...) department underwent an ultrasound examination.The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5-C6 was seen in 4 patients and at C6-C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental

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2015 Journal of pediatric neurosciences

95. Predicting In-Hospital Mortality in Elderly Patients with Cervical Spine Fractures: A Comparison of the Charlson and Elixhauser Comorbidity Measures. (PubMed)

Predicting In-Hospital Mortality in Elderly Patients with Cervical Spine Fractures: A Comparison of the Charlson and Elixhauser Comorbidity Measures. Retrospective analysis of nationally representative data collected for the National Hospital Discharge Survey.To compare the performance of the Charlson and Elixhauser comorbidity-based measures for predicting in-hospital mortality after cervical spine fractures.Mortality occurring as a consequence of cervical spine fractures is very high (...) in the elderly. The Charlson comorbidity measure has been associated with an increased risk of mortality, but its predictive accuracy has yet to be compared with the more recent and increasingly used Elixhauser measure.Using the National Hospital Discharge Survey for the years 1990 through 2007, we identified all patients aged 65 years or older hospitalized with a diagnosis of cervical spine fracture. The association of each Charlson and Elixhauser comorbidity with mortality was assessed in bivariate

2015 Spine

96. Cervical Spine Fracture Presenting as an Orthostatic Headache Secondary to Cerebral Spinal Fluid Leak. (PubMed)

Cervical Spine Fracture Presenting as an Orthostatic Headache Secondary to Cerebral Spinal Fluid Leak. Head injuries are a common chief complaint encountered in the emergency department (ED). A cerebrospinal fluid (CSF) leak resulting from such injuries is uncommon, but has potentially debilitating consequences if undiagnosed.A 34-year-old male patient presented to the ED with complaints of an orthostatic headache after a bicycle accident that occurred 5 days prior to presentation. He presented (...) imaging to rule out such a leak. He was found, on magnetic resonance imaging, to have epidural CSF collections consistent with the suspected leak. In addition to immobilization for the cervical spine fracture, he was treated for orthostatic headaches conservatively with good outcomes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Although this syndrome is still considered rare compared to other posttraumatic injuries, there is a growing body of evidence suggesting it may be underdiagnosed

2015 Journal of Emergency Medicine

97. Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study. (PubMed)

Incidence of traumatic cervical spine fractures in the Norwegian population: a national registry study. The incidence of cervical spine fractures (CS-fx) in the general population is sparingly assessed. The aim of the current study was to estimate the incidence of traumatic CS-fx and of open surgery of cervical spine injuries in the Norwegian population.The Norwegian Patient Register (NPR) is an administrative database that contains activity data from all Norwegian government-owned hospitals (...) met our criteria for severe traumatic cervical spine injury. A total of 2 963 patients had one or more CS-fx, and 285 had severe non-fracture cervical spine injuries. The median age was 54 years, and 69% of the patients were male. The incidence of CS-fx and severe non-fracture injuries in the total Norwegian population was 16.5/100 000/year, and the incidence of CS-fx was 15.0/100 000/year. A total of 18% of the patients were treated with open surgery, resulting in an estimated incidence

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2014 Scandinavian journal of trauma, resuscitation and emergency medicine

98. Concomitant intramedullary arteriovenous malformation and a vertebral hemangioma of cervical spine discovered by a pathologic fracture during bicycle accident. (PubMed)

Concomitant intramedullary arteriovenous malformation and a vertebral hemangioma of cervical spine discovered by a pathologic fracture during bicycle accident. Spinal intramedullary arteriovenous malformations are uncommon and a challenging type of neurosurgical entities. They are rarely located to cervical segment. On the other hand, although hemangiomas are relatively common bone tumors, cervical involvement is again rare and clinically significant ones are infrequent.A 14 year-old-male (...) arteriovenous malformation (AVM) on digital subtraction angiography. Based on neurological and radiological findings, the decision was to treat the patient. After embolization of the AVM, the neurological condition of the patient deteriorated and immediate MRI scan of the cervical spine revealed edema of the spinal cord at the C5-6 level. Thus an emergent surgery was performed and C5-6-7 laminectomies with C5-T2 posterior fixation and arthrodesis were implemented. A second stage operation was carried out

2014 European Spine Journal

99. Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise: A case report and literature review. (PubMed)

with concurrent axis and atlas fractures, which have not been reported. The patient suffered hyperextension injury with neck pain and numbness of the bilateral upper extremity associated with weakness after a 2-m fall. The axis fractures included an odontoid type IIA fracture and traumatic spondylolisthesis of C2-C3. The atlas fracture was unstable. The neurological examination manifested as central canal syndrome, which was due to the hyperextension injury of cervical spine and spondylolisthesis of C2-C3 (...) Posterior arthrodesis of C1-C3 for the stabilization of multiple unstable upper cervical fractures with spinal cord compromise: A case report and literature review. Multiple fractures of the atlas and axis are rare. The management of multiple fragment axis fractures and unstable atlas fractures is still challenging for the spinal surgeon. There are no published reports of similar fractures with 3-part fracture of axis associated with an unstable atlas fracture.We present a patient

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2017 Medicine

100. Posterior pedicle screw fixation to treat lower cervical fractures associated with ankylosing spondylitis: a retrospective study of 35 cases. (PubMed)

Posterior pedicle screw fixation to treat lower cervical fractures associated with ankylosing spondylitis: a retrospective study of 35 cases. The most common site of fractures in patients with ankylosing spondylitis (AS) is the cervical spine, especially the lower cervical spine and cervicothoracic junction. The optimal treatment for cervical spine fractures secondary to AS is controversial. This study aimed to explore the effects of posterior pedicle screw fixation alone on fractures (...) of the lower cervical spine in patients with AS.From January 2006 to January 2013, a total of 35 patients with AS and a lower cervical spine fracture were treated using only posterior cervical/thoracic pedicle screw fixation. In this retrospective study, we reviewed the patients' charts to assess their case histories, operations, neurological outcomes, and complications. We also evaluated their postoperative radiographs to determine the time of bone fusion.Altogether, 32 (91.4%) of the 35 fractures

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2017 BMC Musculoskeletal Disorders

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