Cervical Spine Trauma

Question 1

When can you remove a cervical collar?

Answer 1

If a patient is awake, alert and not intoxicated, does not have posterior cervical tenderness, no neurologic deficits and no distracting injuries; then can clear without radiographs, otherwise obtain:
AP, lateral and open mouth odontoid

Question 2

What two measures are looked at in atlantoaxial instability?

Answer 2

Atlanto-dens interval (ADI) >3.5mm
Space-available for cord (SAC) or PADI
Treated with C1-C2 posterior fusion

Question 3

In treatment of occipitiocervical dislocation what structure is at risk?

Answer 3

Dural venous sinuses

Must place screws in a 2cm triangle with the external occipital protuberance in center

Question 4

How are unstable subaxial cervical spine fractures surgically treated?

Answer 4

Anterior decompression, corpectomy and fusion

1) compression fx with 11° angulation or 25% height loss of vertebral body
2) burst fx with cord compression
3) tear-drop fx with cord compression
4) minimal injury to posterior elements

Question 5

What is the treatment for traumatic sponylolisthesis of the axis (Hangman’s fx)?

Answer 5

Most treated in collar (3mm displacement); if facet dislocation (Type III) then reduction and surgical stabilization

Question 6

How are most cervical lateral mass fractures treated?

Answer 6

two level posterior fusion