Neurologic sequelae of penetrating cervical trauma

Wesley B Vanderlan, Beverly E Tew, Cara Y Seguin, Melanie M Mata, James J Yang, H Mathilda Horst, Farouck N Obeid, Norman E McSwain
Spine 2009 November 15, 34 (24): 2646-53

STUDY DESIGN: Multicenter, retrospective chart analysis was performed using data housed in the trauma registries of 2 independent American College of Surgeons verified, Level I Trauma centers. The trauma registries were queried for all cases of penetrating cervical trauma. Abstracted data included age, sex, race, mechanism of injury, Glasgow Coma Scale (GCS) level on arrival, neurologic findings on arrival, zone of injury, associated injuries, imaging studies and results, operations performed, neurologic sequelae, disposition from the hospital and the presence or absence of neurologic injury, cervical spine fracture, and cervical spine immobilization.

OBJECTIVE: The purpose of this study was to determine the relationship between cervical spine immobilization and neurologic sequelae in penetrating cervical trauma.

SUMMARY OF BACKGROUND DATA: Current recommendations for cervical spine immobilization in penetrating cervical trauma developed by empiric extension of blunt trauma protocols without evidentiary support. No evidence exists to support cervical spine immobilization as a means of preventing neurologic injury progression in cases of penetrating cervical injury.

METHODS: Abstracted data were organized, entered into a database, and compared statistically. Significance was accepted for P<0.05.

RESULTS: A total of 196 patient charts formed the study cohort. Neurologic injuries either improved or remained static. No patient could be determined to have benefited from cervical spine immobilization in this study as the only 2 patients presenting with unstable cervical spine fractures were completely neurologically devastated at the time of injury. Prehospital cervical spine immobilization may have negatively affected patients with vascular and airway injuries. Decreased cervical spine immobilization rates at one institution did not affect neurologic outcome.

CONCLUSION: Cervical spine immobilization does not appear to prevent progression of neurologic injury in cases of penetrating cervical trauma. Comorbid penetrating injuries may be negatively impacted by prehospital cervical spine immobilization.

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