The Surgical Approach to Subaxial Cervical Spine Injuries

Dvorak, Marcel F.; Fisher, Charles G.; Fehlings, Michael G.; Rampersaud, Y. Raja; Öner, F. Cumhur; Aarabi, Bizhan; Vaccaro, Alexander R.

doi:10.1097/brs.0b013e318158ce16

Cited by 183 publications

(60 citation statements)

References 52 publications

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“…Cervical spine subluxations and distraction injuries without canal compromise were managed either by an anterior approach or anterior/posterior decompression and internal immobilization. The surgical techniques undertaken were compatible with algorithms recommended by Dvorak et al’s 45 systematic review (Table 2). The mean time past injury to surgical intervention was 17.8 h (median 12 and range 4–83 h).…”

Section: Methodsmentioning

confidence: 99%

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

et al. 2016

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BACKGROUND Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI. OBJECTIVE To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression. METHODS In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion. RESULTS American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931–0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion. CONCLUSION Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.

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Section: Methodsmentioning

confidence: 99%

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

et al. 2016

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“…Compression fractures are defined by loss of the height of the part or the entire vertebral body, as well as sagittal or coronal plane fractures and “tear-drop” injuries. [12] Sometimes, fractures of the posterior cervical elements can also be found, such as lamina or minimally displaced facet joints/lateral masses fractures. [1] Concomitant root injury in these cases does not preclude nonsurgical treatment according to the SLIC (IV).…”

Section: Resultsmentioning

confidence: 99%

“…A rare clinical scenario of a compression fracture in a patient with a complete neurological deficits would result in a score of three points (V), being managed conservatively according to the system. [12]…”

Section: Resultsmentioning

confidence: 99%

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Cervical injuries scored according to the Subaxial Injury Classification system: An analysis of the literature

Joaquim

Patel

Vaccaro

2014

J Craniovert Jun Spine

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Introduction:The Subaxial Injury Classification (SLIC) system and severity score has been developed to help surgeons in the decision-making process of treatment of subaxial cervical spine injuries. A detailed description of all potential scored injures of the SLIC is lacking.Materials and Methods:We performed a systematic review in the PubMed database from 2007 to 2014 to describe the relationship between the scored injuries in the SLIC and their eventual treatment according to the system score.Results:Patients with an SLIC of 1-3 points (conservative treatment) are neurologically intact with the spinous process, laminar or small facet fractures. Patients with compression and burst fractures who are neurologically intact are also treated nonsurgically. Patients with an SLIC of 4 points may have an incomplete spinal cord injury such as a central cord syndrome, compression injuries with incomplete neurologic deficits and burst fractures with complete neurologic deficits. SLIC of 5-10 points includes distraction and rotational injuries, traumatic disc herniation in the setting of a neurological deficit and burst fractures with an incomplete neurologic deficit.Conclusion:The SLIC injury severity score can help surgeons guide fracture treatment. Knowledge of the potential scored injures and their relationships with the SLIC are of paramount importance for spine surgeons who treated subaxial cervical spine injuries.

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“…A number of subaxial spine injury classification systems have been proposed, most recently the Subaxial Cervical Spine Injury Classification System [234]. The goal of these classification systems is to facilitate decision making when treating such injuries.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

et al. 2017

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Study DesignRetrospective clinical study.PurposeThe purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management.Overview of LiteratureAccording to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management.MethodsA retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively.ResultsSeventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis.ConclusionsPatients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.

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The Surgical Approach to Subaxial Cervical Spine Injuries

Abstract: This algorithm; derived from the Subaxial Injury Classification scoring system, will assist surgeons in answering the 2 most common questions they face when managing subaxial cervical spine trauma: "Should I operate?" and "Which surgical approach should I select?"

Cited by 183 publications

References 52 publications

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury

Cervical injuries scored according to the Subaxial Injury Classification system: An analysis of the literature

Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

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