Cervical Spine Injury

Injuries to Spine are due to blunt trauma in about 90% of cases. the most common injury mechanism:
- motor vehicle accident,
- followed by assault,
- mostly gunshot wounds,
- falls,
- sporting accident
Spine is the common site of injury (61%)

 
How to manage the case:


1. Priorities of Management (Primary Survey)
    This's include :

    a. A (airway)
        check the air way is clear of foreign material, never hyperflexed or hyperextended neck during  these manouvers -> unstable cervical spine injury?
        The cervical spine should be immobilized in cervical collar. Cervical spine injury should be assumed in polytrauma patient until proven otherwised.
    b. B(breathing)  and ventilation
        Is there an abnormal position of trakea?
    c. C (circulation)
        circulation with haemorrage control, level counciousness, skin pallor, blood pressure, temperature and peripheral pulses are important indicator of circulation. Is there hypotension? hypovolaemic shock? need volume replacement?
    d. D (disabillity and neurological status)
       
    e. E (exposure) and environmental control
2. History
    - mechanism of injury is very important, especially the relative energy associated with the injury
3. Examination
    a. Basic an orthopaedic examination includes inspection, palpation, range of motion, strength, stability, and body region-specific tests. In cervical spine injury (or suspected) maintain immobilization in a cervical collar until cervical spin injurry is rulled out radiographically and/or clinically. Logroll patient to examine and palpate the spine.
    b. In upper - extremity or cervical trauma, two-point discrimination of the fingers should be assessed









Source :

Klingensmith et al, 2008, Orthopaedic Injuries : The Washington Manual of Surgery, 5th ed,
        Lippincott Williams & Wilkins, Washington, chapter 34.

Cohn, Stephen M., 2006, Spinal Cord Trauma: Complication in Surgery and Trauma, Informa Health
        Care USA Inc, New York, Pp.491-494.

Anwar et al, 2008, Advanced Trauma Life Support and Multiple Trauma: Classification and
        Diagnosis in Orthopaedic Trauma, 1st ed, Cambridge University Press, New York, Pp.16-20.

Brunicardi, 2007, Orthopaedics: Schwart's Principles of Surgery, 8th ed, McGraw-Hill companies,
        chapter 42