Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Sharif, Salman; Ali, Muhammad; Sih, Ibet Marie; Parthiban, J.K.B.C.; Alves, Óscar L.

doi:10.14245/ns.2040368.184

Cited by 27 publications

(32 citation statements)

References 69 publications

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“…While the American and World Federation of Neurosurgical Societies (WFNS) guidelines on the management of acute cervical spine injuries 2 , 3 do not provide any statement on the post-operative use of cervical orthoses, the corresponding national S1 guideline 1 states that the post-operative use of an orthosis can serve ‘as a prevention measure of extreme movements and as a reminder to support compliance’. The national S1 guideline on ‘subaxial cervical spine injuries’ assumes that an exercise-stable situation can be achieved through surgical treatment of a subaxial cervical spine injury.…”

Section: Discussionmentioning

confidence: 99%

“…Zwölf WSZ (32 %) führen in der 1. postoperativen Woche eine CT-Kontrolle durch. Während die amerikanische Leitlinie sowie die Leitlinie der World Federation of Neurosurgical Societies (WFNS) zum Management akuter Halswirbelsäulen-und Rückenmarkverletzungen [2,3] keine Aussage zur postoperativen Anwendung von Zervikalorthesen treffen, erwähnt die entsprechende nationale S1-Leitlinie [1], dass die postoperative Anlage einer Orthese der "Vermeidung von Extrembewegungen und als Gedächtnisstütze zur Unterstützung der Compliance" dienen kann. Hierbei ist zu erwähnen, dass die nationale S1-Leitlinie "Verletzungen der subaxialen Halswirbelsäule" vom Erreichen einer übungsstabilen Situation durch die operative Therapie einer Verletzung der subaxialen Halswirbelsäule ausgeht.…”

Section: Postoperative Röntgen-und Ct-kontrollenunclassified

“…Verletzungen der subaxialen Halswirbelsäule machen bei Instabilität, Achsabweichung oder Kompression nervaler Strukturen eine operative Stabilisierung des betroffenen Halswirbelsäulenabschnitts notwendig. Prinzipiell sind interne Stabilisierungsverfahren von ventral sowie von dorsal beschrieben, die einzeln oder in Kombination ein- oder zweizeitig, erfolgen können 1 , 2 , 3 . Während die Wahl der operativen Therapie in erster Linie von der Verletzungsmorphologie abhängt und sich auf klinische 4 , 5 , 6 und biomechanisch-experimentelle 7 , 8 , 9 , 10 , 11 , 12 Erkenntnisse stützt, ist die Datengrundlage zur Nachbehandlung postoperativ unzureichend.…”

Section: Introductionunclassified

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Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries – a Survey-based Analysis at German Spine Care Centres

et al. 2021

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Introduction There are no evidence-based recommendations for the post-operative treatment and application of soft or rigid cervical collars after operative treatment of injuries of the subaxial cervical spine. Cervical collars can restrict peak range of motion and serve as a reminder to the patient. However, they can also cause pressure ulcers. The aim of this online-based survey among German spine centres was to gain an overview of post-operative treatment and the application of soft or rigid cervical collars after surgical treatment of injuries of the subaxial cervical spine. Materials and Methods An online-based survey was conducted among 59 spine centres certified by the German Spine Society. It comprised seven items and the option of adding remarks in the form of open-ended responses. Results The return rate was 63% (37 out of 59). Of the 37 analysed spine centres, 51% routinely apply a cervical collar post-operatively, 27% apply a soft and 16% a rigid cervical collar, 8% sequentially apply first a rigid and later a soft cervical collar. Less than half of the spine centres (43%) routinely use no cervical collar. Rigid collars are applied for more than 6 weeks and soft collars up to 6 weeks at some spine centres. Standardised post-operative treatment plans are common. The selection of the post-operative treatment plan depends primarily on the type of injury and method of operation and partly on patient age and bone quality. The satisfaction of German spine centres with the current handling of post-operative treatment of subaxial cervical spine injuries is high. Discussion The post-operative treatment of injuries of the subaxial cervical spine at German spine centres is heterogeneous, and the evidence on advantages and disadvantages of the post-operative application of cervical collars is insufficient. Planning and implementation of randomised controlled clinical trials in subaxial cervical spine injuries is challenging.

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Section: Discussionmentioning

confidence: 99%

Section: Postoperative Röntgen-und Ct-kontrollenunclassified

Section: Introductionunclassified

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Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries – a Survey-based Analysis at German Spine Care Centres

et al. 2021

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“…Allen і R.L. Ferguson найбільш докладно характеризує ушкодження заднього і переднього опорного комплексу, і саме ця класифікація використовується в рекомендаціях визначення тактики Оригінальні дослідження / Original Researches хірургічного лікування травматичних ушкоджень ШВХ на субаксіальному рівні, запропонованих WFNS Spine Committee в 2020 році [22].…”

Section: обговоренняunclassified

Оцінка рівня нестабільності ушкоджень, класифікованих за AOSpine Subaxial Cervical Spine Injury Classification System

Verbov¹

2021

TRAUMA

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Background. The main criteria for determining surgery strategy in patients with traumatic subaxial cervical injury are as follows: the type and degree of damage to the osteo-ligamentous structures of cervical spine that determines the level of instability; the value of spinal cord compression; the state of the sagittal profile. The aim of this study was to assess the degree of instability in different types of cervical spine injuries according to AOSpine Subaxial Cervical Spine Injury Classification System. Materials and methods. We performed a retrospective analysis of Х-ray, computed tomography and magnetic resonance imaging data of 168 patients with traumatic injury of subaxial cervical spine. All of them were hospitalized at the Department of Spinal Cord Pathology of the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine 2008–2018. We assessed the degree of instability using the Cervical Spine Injury Severity Score and determined the type of damage according to the AOSpine Subaxial Cervical Spine Injury Classification System. Results. We found that the median rate of instability increases progressively with increasing severity of injury type. The widest range of instability values is observed in the compression damage: from 6 points (95% confidence interval (CI): 4.76–6.84) in A1 type to 11 points (95% CI: 9.48–11.81) in A4. For A2 and A3 types, we registered 7 (95% CI: 6.68–7.53) and 8 points (95% CI: 7.97–9.01), respectively. A smaller range of values characterizes flexion-extension injuries. The median progressively increases from B1 type — 13 points (95% CI: 12.4–13.92) to B3 type — 15.5 points (95% CI: 14.5–16.35). The value for B2 is intermediate and is 15 points (95% CI: 13.59–15.52). We registered maximum values in flexion-extension injuries — 18 points, for both B2 and B3 types. C type has the highest level of instability — 17 points (95% CI: 16.58–17.86) and a quite wide range of estimated values: from 13 to 20 points. Conclusions. The general trend is an increase in the level of instability in the range from A1 to C injury subtypes, but even A1 type in some cases are quite unstable and require surgery. In contrast to the classical views, type A injuries are often accompanied by da-mage to the facet joints, which must also be taken into account when determining the individual treatment.

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“…У 2020 р. WFNS Spine Committee опублікував оновлені рекомендації щодо принципів терапії травматичних ушкоджень ШВХ на субаксіальному рівні [62]…”

Section: тактика лікуванняunclassified

The classifications of subaxial cervical spine traumatic injuries. Part 6. Ben L. Allen biomechanical classification

Nekhlopochyn¹,

Слынько²,

Verbov³

2021

Ukr Neurosurg J

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Traumatic injuries of subaxial cervical spine are characterized by a wide range of possible pathomorphological changes that depend not only on the direction and intensity of the traumatic force impact, but also on the initial position of cervical spine at the moment of exposure. One of the most detailed classifications of cervical spine traumatic injuries, in which the integrated approach to assessing the type of injury considering the mechanism of injury is used, is the system developed by Ben L. Allen and published with co-authors in 1982. It is also known as the Allen-Ferguson classification and despite long history of existence, still has not lost its relevance. In the classification when characterizing the type of traumatic injury, not only visually detected signs, but also inevitably accompanying changes are given. In total, 6 types of damage were classified: compression-flexion, vertical compression, distraction-flexion, compression-extension, distraction-extension and lateral-flexion, which were divided into stages depending on the severity of pathomorphological changes. The authors of the classification note a pronounced correlation between the nature of damage to anatomical structures and neurological disorders in all patterns of damage. When writing this review, a detailed analysis of the original publication was carried out, highlighting the basic biomechanical aspects that underlie the classification and still have not lost their relevance . It is noted that the schematic images of damages found in modern literature often do not correspond to the description proposed by Ben L. Allen et al., Therefore, when preparing the illustrative material, we relied solely on the data of the original article. Along with the description of morphology, for each type and stage of injury, modern data on possible methods of treatment, both conservative and surgical are given. The complex analysis suggests that the classification developed by Ben L. Allen is a convenient tool for assessing pathomorphological changes and allows choosing the optimal method of treating the patients in each specific clinical situation.

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Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations

Cited by 27 publications

References 69 publications

Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries – a Survey-based Analysis at German Spine Care Centres

Post-operative Use of Cervical Orthoses for Subaxial Cervical Spine Injuries – a Survey-based Analysis at German Spine Care Centres

Оцінка рівня нестабільності ушкоджень, класифікованих за AOSpine Subaxial Cervical Spine Injury Classification System

The classifications of subaxial cervical spine traumatic injuries. Part 6. Ben L. Allen biomechanical classification

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