Risk factors of neurological lesions in low cervical spine fractures and dislocations

Abstract

-Eighty-nine patients with lower cervical spine fractures or dislocations were evaluated for risk factors of neurological lesion. The age, sex, level and pattern of fracture and sagittal diameter of the spinal canal were analysed. There were no significant differences on the age, gender, level and Torg's ratio between intact patients and those with nerve root injury, incomplete or complete spinal cord injuries. Bilateral facet dislocations and burst fractures are a significant risk factor of spinal cord injury.KEY WORDS: cervical spine, fractures, dislocations, spinal cord injury. Fatores de risco de lesão neurológica nas fraturas e luxações da coluna cervical baixaRESUMO -O risco de lesão neurológica foi avaliado em 89 pacientes com fraturas ou luxações da coluna cervical baixa. Foram analisados o sexo, a idade, o diâmetro sagital do canal vertebral, o nível e o tipo de fratura ou luxação. Não foram encontradas diferenças significativas para a idade, sexo, nível da fratura ou luxação e razão de Torg entre os pacientes intactos e aqueles com lesão radicular, lesão medular incompleta e lesão medular completa. Luxações bilaterais de facetas articulares e fraturas em explosão são um fator de risco significativo de lesão neurológica. PALAVRAS-CHAVE: coluna cervical, fratura, luxação, lesão medular.The pattern and the intensity of neurological injury that occurs during lower cervical spine fractures and dislocations have been correlated to many factors. Examples of these factors are the amount of spinal cord disruption 1,2 , and the fracture characteristics and degree of displacement 1,[3][4][5][6][7][8] . The relationship between the degree of displacement and the degree of neurological injury is not unanimously accepted 9,10 .Spinal cord injuries without osteoligamentous injury and severe fracture and dislocations in neurologically intact patients are sometimes seen in daily practice 11,12 . The size of the spinal canal (before the traumatic event) has been naturally interpreted as one of the explanations for this discrepancy, but there is no general agreement in this point [11][12][13][14][15][16][17][18] .In order to identify risk factors for neurological injury, the records of 89 patients who had sustained lower cervical spine trauma were retrospectively reviewed in our institution.

Risk Factors for Neurological Deficiency One Year after Blunt-Induced Traumatic Cervical Fracture

“…Bravo et al [22] previously identified this situation as a significant risk factor for adverse neurological outcome. The finding that vertebral body fractures are significant risk factors for adverse neurological outcome is known in the literature [23]. …”

“…They did not find a significant relation with the type of fracture and the neurological outcome. Coelho et al [23] previously identified risk factors for neurological lesions as a result of fractures and dislocations of the lower cervical spine. They showed that facet dislocations and burst fractures have a greater risk of spinal cord lesions in the lower cervical spine than other lesions.…”

Caring for the patients with cervical spine injuries: what have we learned?

“…The type and location of the CSI, along with hemodynamic stability, would influence the neurological outcome after intubation [64,66,67]. Coelho et al [66] suggested that bilateral facet dislocations and burst fractures have a greater risk of spinal cord lesion in lower C-spine trauma when compared with unilateral facet dislocations and other types of osteoligamentous lesions. It is also a known fact that efficiently performed direct laryngoscopy produces little movement below C3 [68].…”

Prehospital transport of patients with spinal cord injury in Nigeria

“…[1][2][3][4][5][6][7][8] The socioeconomic realities, inadequate immediate attendant care, and the near-absent rehabilitation of people with SCI may be responsible in the developing countries. Studies 9,10 have identified many risk factors [10][11][12][13][14][15][16][17][18][19][20][21][22] for morbidity and mortality in SCI, but none of these risk factors has been studied in the developing world. Nigeria is a country without an organized prehospital transport system for trauma patients.…”