Subaxial Cervical Spine Trauma: Evaluation and Surgical Decision-Making

Abstract

Study Design Literature review. Objective To discuss the evaluation and management of subaxial cervical spine trauma (C3–7). Methods A literature review of the main imaging modalities, classification systems, and nonsurgical and surgical treatment performed. Results Computed tomography and reconstructions allow for accurate radiologic identification of subaxial cervical spine trauma in most cases. Magnetic resonance imaging can be utilized to evaluate the stabilizing discoligamentous complex, the nerves, and the spinal cord. The Subaxial Injury Classification (SLIC) is a new system that aids in injury classification and helps guide the decision-making process of conservative versus surgical treatment. Though promising, the SLIC system requires further validation. When the decision for surgical treatment is made, early decompression (less than 24 hours) has been associated with better neurologic recovery. Surgical treatment should be individualized based on the injury characteristics and surgeon's preferences. Conclusions The current state of subaxial cervical spine trauma is one of great progress. However, many questions remain unanswered. We need to continue to account for the individual patient, surgeon, and hospital circumstances that effect decision making and care.

Surgical treatment of traumatic cervical facet dislocation: anterior, posterior or combined approaches?

“…After clinical screening and patient stabilization, the radiological diagnosis of cervical spinal trauma is made, preferably with a 3D computed tomography (CT) scan with triplanar reconstruction and complemented with magnetic resonance imaging (MRI) when necessary 1,3 . Once the radiological diagnosis of a CFD is made, early reduction may be advisable to avoid additional injury or even improve neurological outcome when SCI is present.…”

“…A cervical spine MRI may be obtained prior to the procedure to rule out a cervical disc herniation, but traction can be safely performed in awake patients with close clinical monitoring of the neurological status even without a cervical MRI (Level of Evidence: III) 4,5 . Typically, the initial weight is 2.5 kg/per injury level and can be performed in neutral, flexion or extension position, according to injury characteristics 1,21 . The patient should be followed clinically and radiologically (with lateral cervical radiography performed in the bed) until reduction is obtained.…”

“…Once the reduction is achieved, it must be kept in traction-inline with weights from 7.5 to 10 kilograms, and some degree of extension, until definitive surgical fixation. This procedure is not recommended in patients whose examination is unreliable (such as obtunded patients or those who are in a coma) and in those with distractive injuries such as atlantoaxial or occipto-cervical dislocation 1,22 .…”

Evaluation of the SLICS use in the treatment of subaxial cervical spine injuries

“…The sub-axial injury classification system (SLICS) was developed by Vaccaro et al to define a classification system for SCST that conveys information about injury patterns and severity as well as treatment considerations and prognosis, such as neurological status and the role of the ligamentous complex in long-term stability 1,8,9 .…”

Management of cervical spine deformity after intradural tumor resection

“…Weight can be increased rapidly, provided neurological and radiographic examinations are repeated, until approximately 20% of the patient's weight is achieved or the patient cannot tolerate further weight. 18 Some surgeons prefer to forgo preoperative traction in favor of intraoperative correction, which prevents the need for preoperative admission and bedrest and their associated complications. In the end, it is the surgeon's preference because there is no evidence that one method is superior to the other.…”