The Functional And Neurological Outcome In Cervical Spine Injuries: A Retrospective Review

摘要

BACKGROUND: Until recently, vertebral injuries were less commonly in cervical spine than Thoracic and lumbar region. With the decline in accidents from mining and other heavy industry and increase in Road traffic accidents, this incidences has change. At present out of significant spinal injury approx. 50% involves the cervical spine and approx. 40% of them lead to quadriplegia and approx. 10% of traumatic cord injuries have no obvious radiographic evidence of vertebral injury (SCIWORA). Aim of this retrospective case-series with 25 patients was to assess Neurological and functional outcome in Cervical Spine Injuries. RESULTS: There were 10 patients with lower cervical spine fractures (C3-C7),5 patients with upper cervical fractures,10 patients had SCIWORA injuries. Initial ASIA scale: A:4,B:3,C:5, D:8 & E:5. 15 patients were treated conservatively with cervical tongs and orthotics. Rest of 10 patients treated operatively with anterior cervical platting. Full neurological recovery in 10 patients and 40% of patients had poor neurological outcome , which is significantly higher. 5 patients (20%) were associated with glutei sores or cranial sores. 3 patients had chest infection due to respiratory pneumonitis, 3 patients had major depression (psychological complication).Operative patients were commonly associated with cardio respiratory compromise most probably due to ascending cord edema, in 24% patients. CONCLUSIONS: To conclude cervical spine injury is continuing to be fatal and paralyzing injury with poor and unpredictable neurological outcome. Final neurological outcome is depends on primary neurological damage. SCIWORA type of cervical spine injury and stable cervical spine fractures associated with good neurological outcome. Poor Neurological Outcome is associated with High velocity trauma and unstable, lower cervical spine bony injury. Functional Outcome mostly depends on final neurological outcome and can be improved with proper rehabilitation programme. Introduction In general, approximately 2% to 6% of trauma patients sustain a cervical spine fracture. Of those trauma patients sustaining a spinal injury, more than half of the spinal injuries involve the cervical region. Fractures of C6 and C7 account for nearly 40 percent of cervical spine injuries after blunt trauma. 1 Because of differences in spinal canal dimensions and the mechanisms of injury, spinal cord damage is more frequently associated with lower rather than upper cervical spine fractures and dislocations.Advances in prehospital emergent management and critical care in specialized trauma centers have improved survival from these injuries over the past few decades. In these series, Canadian C-spine rules had laid few criteria for the better approach and to improve management. 2 There were also strict rules regarding radiological clearance as per criteria given by NEXUS (National Emergency X-ray Utilization study).3 But the improvement in outcome is not been yet established. The use of steroids also standardized with NASCIS protocol III. High doses are required. Most benefit occurs in the first 8 hours, and additional effect occurs within the first 24 hours.4 Three large-scale randomized clinical trials have investigated methylprednisolone in the treatment of spinal cord injury.5,6,7 But steroids did not improve neural recovery in quadriplegics and their use was associated with gastrointestinal hemorrhage.Cervical spine injuries, classified according to stability, neurological deficit, type of injury –bony or soft tissue injury (SCIWORA).but all these classification, associated with lack of reproducibility. The system of Allen et al 8 is the most frequently cited and used classification for subaxial cervical spine injuries. Despite this, it has not been validated, retrospectively or prospectively, since its publication in 1982. Intraobserver and interobserver reliability has not been tested and the significance of the injury groups on treatment decision making