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Cervical Spine Fracture

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141. Lumbar Spine Fractures and Dislocations (Diagnosis)

fractures of the vertebral column each year, and 11,000 of these patients sustain spinal cord injuries. [ ] The thoracolumbar spine and lumbar spine are the most common sites for fractures because of the high mobility of the lumbar spine compared to the more rigid thoracic spine. [ ] Injury to the cord or cauda equina occurs in approximately 10-38% of adult thoracolumbar fractures and in as many as 50-60% of fracture dislocations. The rate of bony injury without neurologic consequence is undoubtedly (...) > Lumbar Spine Fractures and Dislocations Updated: Oct 16, 2018 Author: Federico C Vinas, MD; Chief Editor: Jeffrey A Goldstein, MD Share Email Print Feedback Close Sections Sections Lumbar Spine Fractures and Dislocations Overview Background Each year, more than 150,000 persons in North America sustain fractures of the vertebral column. Injuries to the thoracolumbar and lumbar spine constitute most of these fractures. The immediate neurologic damage that accompanies the bony destruction results

2014 eMedicine Surgery

142. Lumbar Spine Fractures and Dislocations (Treatment)

, Hurlbert RJ, Anderson P, Fehlings M, Rampersaud R, Massicotte EM, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine (Phila Pa 1976) . 2006 Feb 15. 31 (4):451-8. . Kinoshita T, Ebara S, Kamimura M, Tateiwa Y, Itoh H, Yuzawa Y, et al. Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients. J Bone Miner Metab . 1999. 17 (3):201-5. . Castaño-Betancourt MC (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2NDE5MS10cmVhdG1lbnQ= processing > Lumbar Spine Fractures and Dislocations Treatment & Management Updated: Oct 16, 2018 Author: Federico C Vinas, MD; Chief Editor: Jeffrey A Goldstein, MD Share Email Print Feedback Close Sections Sections Lumbar Spine Fractures and Dislocations Treatment Approach Considerations The decision whether to perform surgery in the acute setting is made by the surgeon, depending on the stability of the fracture, the radiologic evidence of spinal cord or cauda equina compression

2014 eMedicine Surgery

143. Lumbar Spine Fractures and Dislocations (Overview)

fractures of the vertebral column each year, and 11,000 of these patients sustain spinal cord injuries. [ ] The thoracolumbar spine and lumbar spine are the most common sites for fractures because of the high mobility of the lumbar spine compared to the more rigid thoracic spine. [ ] Injury to the cord or cauda equina occurs in approximately 10-38% of adult thoracolumbar fractures and in as many as 50-60% of fracture dislocations. The rate of bony injury without neurologic consequence is undoubtedly (...) > Lumbar Spine Fractures and Dislocations Updated: Oct 16, 2018 Author: Federico C Vinas, MD; Chief Editor: Jeffrey A Goldstein, MD Share Email Print Feedback Close Sections Sections Lumbar Spine Fractures and Dislocations Overview Background Each year, more than 150,000 persons in North America sustain fractures of the vertebral column. Injuries to the thoracolumbar and lumbar spine constitute most of these fractures. The immediate neurologic damage that accompanies the bony destruction results

2014 eMedicine Surgery

144. Lumbar Spine Fractures and Dislocations (Follow-up)

, Hurlbert RJ, Anderson P, Fehlings M, Rampersaud R, Massicotte EM, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma--a multicenter study. Spine (Phila Pa 1976) . 2006 Feb 15. 31 (4):451-8. . Kinoshita T, Ebara S, Kamimura M, Tateiwa Y, Itoh H, Yuzawa Y, et al. Nontraumatic lumbar vertebral compression fracture as a risk factor for femoral neck fractures in involutional osteoporotic patients. J Bone Miner Metab . 1999. 17 (3):201-5. . Castaño-Betancourt MC (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2NDE5MS10cmVhdG1lbnQ= processing > Lumbar Spine Fractures and Dislocations Treatment & Management Updated: Oct 16, 2018 Author: Federico C Vinas, MD; Chief Editor: Jeffrey A Goldstein, MD Share Email Print Feedback Close Sections Sections Lumbar Spine Fractures and Dislocations Treatment Approach Considerations The decision whether to perform surgery in the acute setting is made by the surgeon, depending on the stability of the fracture, the radiologic evidence of spinal cord or cauda equina compression

2014 eMedicine Surgery

145. Deep Venous Thrombosis and Thromboembolism in Patients With Cervical Spinal Cord Injuries

encountered in patients who have sustained cervical spinal cord injuries. Several means of prophylaxis and treatment are available, including anticoagulation, pneumatic compression devices, and vena cava filters. In 2002, the guidelines author group of the Joint Section on Disorders of the Spine and Peripheral Nerves of the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) produced a medical evidence-based guideline on this important topic. The purpose (...) was that postoperative pharmacologic thromboprophylaxis was unnecessary in patients with cervical spinal injuries without SCI; however, it was recommended in instances of cervical spine trauma with SCI or patients treated with anterior thoracolumbar procedures, irrespective of SCI. It was recommended that pharmacologic thromboprophylaxis be initiated preoperatively as soon as possible in patients with SCI and in cases requiring a delay in surgical treatment. Pharmacologic prophylaxis was recommended

2013 Congress of Neurological Surgeons

146. Treatment of Subaxial Cervical Spinal Injuries (Full text)

Injuries Ankylosing Spondylosis SCIENTIFIC FOUNDATION Individual subaxial cervical spine injuries represent a wide spectrum of damage to the anatomic structures of the neck, including fractures, ligamentous injury, and disk disruption, often with injury to the cervical spinal cord and nerve roots. Although each injury is unique in terms of the particular complex of bone and soft-tissue disruption, some type of classification is necessary as an intellectual framework to develop consistent treatment (...) with subaxial cervical fracture injuries treated primarily with surgery died. One patient was neurologically worse after surgery. Three patients healed successfully without instability. – Four additional reports concerning the care of patients with AS and subaxial cervical spinal injuries were identified in the current literature search. Cornefjord et al published a retrospective case series (Class III medical evidence) of 19 patients with AS and subaxial cervical spine fractures treated with posterior

2013 Congress of Neurological Surgeons PubMed abstract

147. Clinical Assessment Following Acute Cervical Spinal Cord Injury (Full text)

Classification of Spinal Injury Patients . Chicago, IL : ASIA ; 1989 . 10. ASIA/IMSOP . Standards for Neurological and Functional Classification of Spinal Cord Injury—Revised 1992 . Chicago, IL : ASIA ; 1992 . 11. ASIA/IMSOP . International Standards for Neurological and Functional Classification of Spinal Cord Injury--Revised 1996 . Chicago, IL : ASIA ; 1996 . 12. Benzel EC , Larson SJ Functional recovery after decompressive spine operation for cervical spine fractures . Neurosurgery . 1987 ; 20 ( 5 ): 742 (...) following acute spinal cord injury. In: Guidelines for the management of acute cervical spine and spinal cord injuries . Neurosurgery . 2002 ; 50 ( 3 suppl): S21 – S29 . 2. Savic G , Bergström E , Frankel HL , Jamous MA , Jones PW Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards . Spinal Cord . 2007 ; 45 ( 6 ): 444 – 451 . 3. Marino RJ , Graves DE Metric properties of the ASIA motor score: subscales improve correlation

2013 Congress of Neurological Surgeons PubMed abstract

148. Prehospital Cervical Spinal Immobilization After Trauma (Full text)

of the injured cervical spine may create or exacerbate cervical spinal cord or cervical nerve root injury. – , , , This potential has led to the use of spinal immobilization for trauma patients who have sustained a cervical vertebral column injury or experienced a mechanism of injury that could result in cervical spinal column injury. , , – , , , , , , Kossuth , is credited with pioneering the currently accepted methods of protection and immobilization of the cervical spine during extrication of acute injury (...) column immobilization techniques. Even when the analysis was limited to cervical spine injuries, no significant protective effect from spinal immobilization was identified. For multiple reasons, the conclusions drawn by the authors of this study are considered spurious at best. , , Evidence in the literature evaluating the effectiveness of prehospital spinal immobilization is sparse. Ethical and practical issues preclude the execution of a contemporary, randomized clinical trial designed to study

2013 Congress of Neurological Surgeons PubMed abstract

149. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

-thirds of the participants (67%) had separate protocols regarding aspirin (acetylsalicylic acid [ASA]) or nonsteroidal anti-inflammatory drugs (NSAIDs). Moreover, 55% stopped ASA before spinal cord stimulation (SCS) trials and implants, and 32% stopped ASA before epidural steroid injections (ESIs). However, 17% admitted that they used different protocols for cervical spine injections as compared with lumbar spine injections. Most did not express familiarity with selective serotonin reuptake (...) in the upper thoracic spine, 4.1 mm at the T11–T12, and 4 to 7 mm in the lumbar regions. The epidural space has extensive thin-walled, valveless venous plexi (plexus venous vertebralis interior, anterior, and posterior), which are vulnerable to damage during needle placement and advancement of spinal cord stimulator leads and epidural and intrathecal catheters. These epidural veins are mainly found in anterior and lateral aspects of the epidural space. Furthermore, the fragility of these vessels increases

2018 American Society of Regional Anesthesia and Pain Medicine

150. Spine Surgery

., subsidence, surrounding radiolucency, dislocation/subluxation, vertebral body fracture or hardware breakage) Progressive neck pain or deformity following prior posterior cervical decompressive laminectomy or laminoplasty Cervical laminoplasty may be indicated for treatment of following conditions: Multilevel Spinal stenosis of the cervical spine, when all of the following requirements are met: ? Clinical signs and symptoms of myelopathy which may include: loss of dexterity, urinary urgency, new-onset (...) . Corpectomy -- Corpectomy typically reflects a longitudinal resection of the vertebral body from disc space to disc space often resulting in a destabilization of the complex. In the cervical spine, at least 50% of the vertebral body is removed and in the thoracic/lumbar spine, at least 30% of the corpus is removed. Copyright © 2018. AIM Specialty Health. All Rights Reserved. Spine Surgery 7 Criteria Cervical decompression with or without fusion may be indicated to treat any of the following conditions

2018 AIM Specialty Health

151. Appropriate Use Criteria: Imaging of the Spine

tumor assessment; developmental vertebral abnormalities) and CT myelography Abnormalities detected on other imaging studies which require additional clarification to direct treatment Fracture evaluation ? Following initial evaluation with radiographs Post-myelogram CT or CT following other cervical spine interventional procedure Post-trauma ? Neurologic deficit with possible spinal cord injury ? Progressively worsening pain Significant acute trauma to the cervical spine region When the patient’s (...) clarification to direct treatment Chiari malformation (Arnold-Chiari malformation) Congenital spine anomalies ? Cervical spine dysraphism and other congenital anomalies involving the cervical spine and/or spinal cord ? Congenital vertebral defects for assessment of bony defects such as segmentation and fusion anomalies Fracture evaluation ? Following initial evaluation with radiographs Infectious process ? Including but not limited to the following: ? Abscess ? Osteomyelitis ? Discitis Multiple sclerosis

2018 AIM Specialty Health

152. Treatment strategy of unstable atlas fracture: A retrospective study of 21 patients. (Full text)

Treatment strategy of unstable atlas fracture: A retrospective study of 21 patients. At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we (...) introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long

2020 Medicine PubMed abstract

153. Lower Cervical Spine Fractures and Dislocations (Diagnosis)

to immobilize the cervical spine affected by polio. Its application was extended to trauma cases, providing a better means of immobilization. Next: Anatomy The subaxial cervical spine can conveniently be divided into anterior and posterior columns. The anterior column consists of the typical cervical vertebral body sandwiched between supporting disks. The anterior surface is reinforced further by the anterior longitudinal ligament, and the posterior body by the posterior longitudinal ligament, both of which (...) MA, Rand N. Cervical spine anatomy. Spine State of the Art Reviews . 2000. 14(3):521-32. Allen BL Jr, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976) . 1982 Jan-Feb. 7 (1):1-27. . Zehnder SW, Lenarz CJ, Place HM. Teachability and reliability of a new classification system for lower cervical spinal injuries. Spine (Phila Pa 1976) . 2009 Sep 1. 34(19):2039-43. . Hubbard ME, Jewell RP

2014 eMedicine Surgery

154. Fracture, Cervical Spine (Treatment)

posterior ligamentous disruption must occur. Since the fragment displaces anteriorly, a significant degree of anterior ligamentous disruption exists. This injury involves disruption of all 3 columns, making this an extremely unstable fracture that frequently is associated with spinal cord injury. Initial management is application of traction with cervical tongs. Anterior subluxation Anterior subluxation in the cervical spine occurs when posterior ligamentous complexes (nuchal ligament, capsular (...) for cervical traction is warranted. If displacement is less than 6.9 mm, the transverse ligament is still competent and neurologic injury is unlikely. Burst fracture of the vertebral body When downward compressive force is transmitted to lower levels in the cervical spine, the body of the cervical vertebra can shatter outward, causing a burst fracture. This fracture involves disruption of the anterior and middle columns, with a variable degree of posterior protrusion of the latter. Radiographically

2014 eMedicine Emergency Medicine

155. Lower Cervical Spine Fractures and Dislocations (Treatment)

deterioration in the face of persistent compression from bone or disk fragments Although malalignment can be managed initially with cervical tong traction, definitive surgical stabilization, with or without decompression, generally is required. Anterior-column trauma may result from axial loading injuries in combination with flexion, extension, or rotational moments. Typically, the burst fracture or teardrop variant occurs with translation of bony fragments into the spinal canal. [ , , ] Direct trauma (...) Initial surgical management focuses on the specific injury encountered. Such injuries may be classified into the following three categories: Those involving primarily the anterior column or vertebral body Those involving the posterior column with pedicle, facet, or lamina injury Those involving both columns Spinal realignment generally is emphasized. This begins with the application of cervical tongs and continues by serially increasing traction until normal spinal alignment is achieved and bony

2014 eMedicine Surgery

156. Fracture, Cervical Spine (Diagnosis)

posterior ligamentous disruption must occur. Since the fragment displaces anteriorly, a significant degree of anterior ligamentous disruption exists. This injury involves disruption of all 3 columns, making this an extremely unstable fracture that frequently is associated with spinal cord injury. Initial management is application of traction with cervical tongs. Anterior subluxation Anterior subluxation in the cervical spine occurs when posterior ligamentous complexes (nuchal ligament, capsular (...) for cervical traction is warranted. If displacement is less than 6.9 mm, the transverse ligament is still competent and neurologic injury is unlikely. Burst fracture of the vertebral body When downward compressive force is transmitted to lower levels in the cervical spine, the body of the cervical vertebra can shatter outward, causing a burst fracture. This fracture involves disruption of the anterior and middle columns, with a variable degree of posterior protrusion of the latter. Radiographically

2014 eMedicine Emergency Medicine

157. Lower Cervical Spine Fractures and Dislocations (Overview)

to immobilize the cervical spine affected by polio. Its application was extended to trauma cases, providing a better means of immobilization. Next: Anatomy The subaxial cervical spine can conveniently be divided into anterior and posterior columns. The anterior column consists of the typical cervical vertebral body sandwiched between supporting disks. The anterior surface is reinforced further by the anterior longitudinal ligament, and the posterior body by the posterior longitudinal ligament, both of which (...) MA, Rand N. Cervical spine anatomy. Spine State of the Art Reviews . 2000. 14(3):521-32. Allen BL Jr, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976) . 1982 Jan-Feb. 7 (1):1-27. . Zehnder SW, Lenarz CJ, Place HM. Teachability and reliability of a new classification system for lower cervical spinal injuries. Spine (Phila Pa 1976) . 2009 Sep 1. 34(19):2039-43. . Hubbard ME, Jewell RP

2014 eMedicine Surgery

158. Lower Cervical Spine Fractures and Dislocations (Follow-up)

deterioration in the face of persistent compression from bone or disk fragments Although malalignment can be managed initially with cervical tong traction, definitive surgical stabilization, with or without decompression, generally is required. Anterior-column trauma may result from axial loading injuries in combination with flexion, extension, or rotational moments. Typically, the burst fracture or teardrop variant occurs with translation of bony fragments into the spinal canal. [ , , ] Direct trauma (...) Initial surgical management focuses on the specific injury encountered. Such injuries may be classified into the following three categories: Those involving primarily the anterior column or vertebral body Those involving the posterior column with pedicle, facet, or lamina injury Those involving both columns Spinal realignment generally is emphasized. This begins with the application of cervical tongs and continues by serially increasing traction until normal spinal alignment is achieved and bony

2014 eMedicine Surgery

159. Fracture, Cervical Spine (Overview)

posterior ligamentous disruption must occur. Since the fragment displaces anteriorly, a significant degree of anterior ligamentous disruption exists. This injury involves disruption of all 3 columns, making this an extremely unstable fracture that frequently is associated with spinal cord injury. Initial management is application of traction with cervical tongs. Anterior subluxation Anterior subluxation in the cervical spine occurs when posterior ligamentous complexes (nuchal ligament, capsular (...) for cervical traction is warranted. If displacement is less than 6.9 mm, the transverse ligament is still competent and neurologic injury is unlikely. Burst fracture of the vertebral body When downward compressive force is transmitted to lower levels in the cervical spine, the body of the cervical vertebra can shatter outward, causing a burst fracture. This fracture involves disruption of the anterior and middle columns, with a variable degree of posterior protrusion of the latter. Radiographically

2014 eMedicine Emergency Medicine

160. Fracture, Cervical Spine (Follow-up)

posterior ligamentous disruption must occur. Since the fragment displaces anteriorly, a significant degree of anterior ligamentous disruption exists. This injury involves disruption of all 3 columns, making this an extremely unstable fracture that frequently is associated with spinal cord injury. Initial management is application of traction with cervical tongs. Anterior subluxation Anterior subluxation in the cervical spine occurs when posterior ligamentous complexes (nuchal ligament, capsular (...) for cervical traction is warranted. If displacement is less than 6.9 mm, the transverse ligament is still competent and neurologic injury is unlikely. Burst fracture of the vertebral body When downward compressive force is transmitted to lower levels in the cervical spine, the body of the cervical vertebra can shatter outward, causing a burst fracture. This fracture involves disruption of the anterior and middle columns, with a variable degree of posterior protrusion of the latter. Radiographically

2014 eMedicine Emergency Medicine

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