Figure 25.1
CT image demonstrating rotational instability of C1 on C2
Figure 25.2
CT image demonstrating a spinous process fracture in the cervical spine
Ensure collar in place immediately if any injury is suspected.
Ensure adequate resuscitation and maintinence of mean arterial pressure if concern for spinal cord injury.
When to Escalate
- 1.
Any evidence of cervical spinal fusion, either from ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis (DISH), or previous surgical arthrodesis
- 2.
Jumped/perched facets, severely displaced odontoid or hangman’s fractures, or any injury possibly necessitating emergent reduction
- 3.
Neurologic deficits, especially if the exam is worsening
Imaging
- 1.
May consider a plain radiograph series including AP, lateral, and open-mouth odontoid views.
- 2.
Generally, all patients with cervical spine injuries will have CT scans of the cervical spine.
- 3.
MRI should be performed if there are neurologic deficits, if the patient is obtunded, and prior to most closed reduction attempts.
Effective Communication
- 1.
Neurologic status is crucialRelated posts:
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