Emergency,spine trauma,acute spinal cord injury

Post-traumatic spinal epidural hematomas are uncommon, usually requiring emergent neurosurgical evacuation. We present a symptomatic delayed post-traumatic epidural hematoma of the T-spine that resolved within hours of administration of high dose steroids. A 22-year-old man presented 10 days after sustaining blunt trauma during a motor vehicle crash. He developed signs of acute cord compression with loss of sensation and motor function in bilateral lower extremities with priapism. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 50% canal stenosis at the T4 level...

OBJECTIVE: To review the case of a patient who suffered a cervical spine fracture-dislocation missed at a hospital emergency department. CLINICAL FEATURES: A 77-year-old man involved in a motor vehicle accident was transported to a local emergency hospital where cervical spine x-ray films taken were reported as demonstrating no evidence of acute injury. The patient visited a chiropractic clinic 6 days later, where x-ray films were again obtained, finding that the patient sustained fractures of C5 and C6, as well as a bilateral facet dislocation at C5/C6...

OBJECT: The authors attempted to determine if there is a significant relationship between the incidence of medical complications and the prophylactic use of methylprednisolone (MP) during spine surgery in patients with acute spinal cord injury (SCI) who had already received MP on hospital admission (typically in the setting of an Emergency Room/Trauma Center). METHODS: The authors studied 73 patients with acute SCI who were admitted to the hospital for at least 7 days postinjury...

We describe a term infant with an acute spinal cord injury following emergency Caesarean section. Foetal movements were normal on the day that the mother was admitted for postterm induction of labour. Caesarean section was performed because of foetal distress and failure to progress during labour. The initial clinical picture suggested acute birth asphyxia. The presence of a high cervical spine injury became more obvious as the clinical picture evolved over the next 7 days. A discontinuity of the cervical spinal cord at C4-5 was confirmed on MRI...

BACKGROUND: Traditionally, odontoid fractures have been treated with different bracing techniques resulting in variable degrees of successful healing. Surgical intervention is becoming more widely practiced as a primary intervention. The purpose of this report was to survey our recent experience in southern Alberta to determine potential outcome differences in management strategies. METHODS: We retrospectively reviewed the charts of 520 patients diagnosed with cervical spine fractures over a six-year period from January 1990, through December 1996...

At the authors' institution, a multidisciplinary team of trauma physicians, neurosurgeons, and anesthesiologists evaluates patients with suspected spinal cord injury. Our initial goal after resuscitation and evaluation is to assure adequate tissue oxygenation through blood pressure support and oxygen supplementation. This supplementation helps ensure maximal oxygen delivery to the injured spinal cord. It is important that a detailed and standardized neurologic examination is performed and repeated often to detect neurologic decline...

OBJECTIVES: To assess trends in emergency, acute, and surgical management of spinal cord injury (SCI), and evaluate the relations between surgery and the occurrence of specific complications. SETTING: Model SCI Care Systems. DESIGN: Case series. PARTICIPANTS: Consecutive samples of 3,756 acute spinal injuries admitted to the Midwest Regional Spinal Cord Injury Care System between 1990 and 1999, 2,204 individuals admitted to a Model SCI System within 24 hours of injury before 1995, and 941 individuals who were injured between December 1995 and August 1998 and were admitted to a Model System within 24 hours of injury...

Atlanto-occipital dislocation occurs more often in children due to the laxity of the ligamentous structures anchoring the occiput to the axial skeleton. The mechanism of action usually involves a sudden acceleration-deceleration force on the head of the child. The dislocation usually severs the spinal cord at the foramen magnum, resulting in acute respiratory arrest. We have managed four patients who sustained this injury and arrived at our trauma center with signs of life. Two patients were hemodynamically unstable, had positive diagnostic peritoneal lavage, and underwent splenectomy...

A quarter of a century ago, in October 1964, the first spinal cord injury center in Switzerland was opened at Geneva University Hospital. At that time all para- and tetraplegics were classified as "high-risk" patients. Early mortality, covering the initial four weeks following trauma, was still around 15%. The available resources for diagnostic assessment were limited to clinical examination and neuroradiological assessment (subsequently improved by the introduction of tomography and gas myelography). A great many patients suffered a deteriorated neurological level due to inadequate, multiple transfers between hospitals...

We report the case of a patient who sustained a scissors-type blunt neck trauma and survived the following injuries: comminuted cricoid fracture, complete cricotracheal separation, interruption of the recurrent laryngeal nerves bilaterally, multiple cervical vertebral fractures, and a third cervical cord transection. He was rendered apneic instantly at the accident site and was immediately resuscitated by coworkers by mouth-to-mouth resuscitation. Attempts at endotracheal intubation to establish an initial airway caused acute airway occlusion and an emergency tracheostomy was then successfully performed...

The use of contrast myelography in the evaluation of acute cervical spinal cord trauma is controversial. The purpose of employing such a technique is to demonstrate any persistent extradural cord compression after the spine is realigned by skeletal traction. The surgical correction of such compression may result in enhanced neurological recovery. The "mini-myelogram" is accomplished by performing a lateral C1/C2 spinal puncture and injecting a low volume of Pantopaque into the subarachnoid space. Demonstration of significant extradural compression results in emergency surgery for appropriate decompression...

The charts of 81 patients with acute cervical spine fracture and/or subluxation were reviewed to determine the incidence of injury to the soft tissue and bone of the head or face in these patients. Motor vehicle accidents accounted for over 69% of these injuries. Only 33 patients had concomitant soft tissue injury to the head or face, and only five had facial and/or skull fractures. Injuries of the skull and face do not usually accompany cervical fractures, and our findings do not support the restriction of post-traumatic cervical spine radiography in the emergency department to patients with obvious head or facial trauma...

The recognition and appropriate initial management of the patient with an acute cervical spine injury in the ED is important because of the devastating and catastrophic effects of spinal cord injury. The use of computed tomography (CT) scan compared with initial plain radiographs in the detection of acute blunt traumatic cervical spine injury was evaluated in 20 patients. There was a disparity between the plain film and the CT scan as read by an attending radiologist in 12 patients (60%). In five patients (25%) the plain radiograph suggested a fracture or dislocation that was confirmed by CT scan...

Results in ten patients admitted with the diagnosis of complete traumatic quadriplegia and with fracture-dislocation of the cervical spine are reviewed. Emphasis is placed on aggressive emergency surgical treatment of these lesions such as tracheostomy, laminectomy and cord cooling, incorporated into a detailed protocol of overall management.