Delayed diagnosis of cervical spine injuries. Gerrelts BD, Petersen EU, Mabry J, Petersen SR. Emergency medicine: a comprehensive study guide. The adequacy and cost effectiveness of routine resuscitation-area cervical-spine radiographs. Spain DA, Trooskin SZ, Flancbaum L, Boyarsky AH, Nosher JL. Limitations of cervical radiography in the evaluation of acute cervical trauma. Asymptomatic occult cervical spine fracture: case report and review of the literature. Isolated head injuries versus multiple trauma in pediatric patients: do the same indications for cervical spine evaluation apply?. Laham JL, Cotcamp DH, Gibbons PA, Kahana MD, Crone KR. Clinical prediction of cervical spine injuries in children. Rachesky I, Boyce WT, Duncan B, Bjelland J, Sibley B. Utility of the cervical spine radiograph in pediatric trauma. Lally KP, Senac M, Hardin WD, Haftel A, Kaehler M, Mahour GH. Diagnostic imaging of cervical spine injuries. Clinical indications for cervical spine radiographs in alert trauma patients. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Hoffman JR, Schriger DL, Mower W, Luo JS, Zucker M. Clinical indications for cervical spine radiographs in the traumatized patient. 1988 17:792-6.īachulis BL, Long WB, Hynes GD, Johnson MC. Rational ordering of cervical spine radiographs following trauma. Ringenberg BJ, Fisher AK, Urdaneta LF, Midthun MA.
Reliability of indications for cervical spine films in trauma patients. Kreipke DL, Gillespie KR, McCarthy MC, Mail JT, Lappas JC, Broadie TA. In patients with delayed symptoms, many have neurologic symptoms at the time of the injury, such as paresthesias or weakness, that have subsequently resolved. However, up to 30 percent of patients have a delayed onset of neurologic abnormalities, which may not occur until up to four or five days after the injury. Paralysis may be present on the patient's arrival in the emergency department. 31 This situation may account for up to 70 percent of spinal cord injuries in children and is most common in children younger than eight years. As a result, the spinal cord also undergoes stretching, leading to neuronal injury or, in some cases, complete severing of the cord. SCIWORA syndrome occurs when the elastic ligaments of a child's neck stretch during trauma. This situation has been named “SCIWORA” ( spinal cord injury with out radiographic abnormality) syndrome. In children, it is not uncommon for a spinal cord injury to show no radiographic abnormalities. Unilateral facet dislocations ( Figure 5)Īnterior dislocation of 25 to 33% of one cervical vertebra on lateral views an abrupt transition in rotation so that lateral view of affected vertebra is rotated lateral displacement of spinous process on anteroposterior viewįlexion, such as when picking up and throwing heavy loads (such as snow or clay)Īvulsion of posterior aspect of spinous process frequently an incidental findingĪ special situation involving children deserves mention. Large wedge off the anterior aspect of affected vertebra ligamentous instability causes alignment abnormalitiesĪnterior displacement of 50% or more of one cervical vertebra on lateral views Occurs with sudden deceleration (hanging) and with hyperextension, as in motor vehicle accidentsīilateral pedicle fracture of C2 with or without anterior subluxation lateral view required May be difficult to see on plain films high clinical suspicion requires CT scanning Occurs in patients with Down syndrome, rheumatoid arthritis and other destructive processesĪsymmetric lateral bodies on odontoid view, increased predental space Once an injury to the spinal cord is diagnosed, methylprednisolone should be administered as soon as possible in an attempt to limit neurologic injury.īurst fracture occurs with axial load or vertebral compressionĭisplaced lateral aspects of C1 on odontoid view, predental space more than 3 mm The “SCIWORA” syndrome (spinal cord injury without radiographic abnormality) is common in children. The most common reason for a missed cervical spine injury is a cervical spine radiographic series that is technically inadequate. The lateral view must include all seven cervical vertebrae as well as the C7-T1 interspace, allowing visualization of the alignment of C7 and T1. Views required to radiographically exclude a cervical spine fracture include a posteroanterior view, a lateral view and an odontoid view. Significant cervical spine injury is very unlikely in a case of trauma if the patient has normal mental status (including no drug or alcohol use) and no neck pain, no tenderness on neck palpation, no neurologic signs or symptoms referable to the neck (such as numbness or weakness in the extremities), no other distracting injury and no history of loss of consciousness.