====== Cervical spine injury treatment ====== {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1TAHVG_L--CUI8nZZJvmfBP9SeP8n_xVRqrhv3Om3n-UagDkCY/?limit=15&utm_campaign=pubmed-2&fc=20221210022251}} ---- If a patient arrives with an intact [[neurologic examination]] despite [[gunshot wound]] or [[stab wound]]s to the [[neck]], the incidence of a cervical spine injury that requires a therapeutic intervention is minute. As a result, in a neurologically intact and examinable patient, a [[cervical collar]] should be immediately removed to facilitate the remaining components of the diagnostic evaluation ((Ball CG. Penetrating nontorso trauma: the head and the neck. Can J Surg. 2015 Aug;58(4):284-5. Review. PubMed PMID: 26022154; PubMed Central PMCID: PMC4512872. )). Treatment of subaxial cervical spinal injury remains controversial. Both the anterior and posterior procedures have serious advantages and disadvantages ((Hadley MN. Treatment of subaxial cervical spinal injuries. Neurosurgery. 2002;50(3):S156–S165.)) ((Maiman DJ, Barolat G, Larson SJ. Management of bilateral locked facets of the cervical spine. Neurosurgery. 1986;18(5):542–547. doi: 10.1097/00006123-198605000-00005.)) ((Payer M. Clinical Article: Immediate open anterior reduction and antero-posterior fixation/fusion for bilateral cervical locked facets. Acta Neurochir. 2005;147:509–514. doi: 10.1007/s00701-005-0502-x.)). ---- If a [[cervical spine fracture]] is suspected, the [[neck]] should be immobilized immediately in a [[cervical collar]] and backboard. If the cervical spine is out of alignment, [[cervical traction]] is applied to realign the spine. Steroids may be administered to control spinal cord damage and inflammation. ---- Patients with [[cervical spine fracture]]-dislocation who cannot be examined during attempted closed [[reduction]], or before open posterior reduction, should undergo cervical MRI before attempted reduction. The presence of a significant herniated disc in this setting is a relative indication for anterior decompression (e.g. by an [[anterior cervical discectomy and fusion]] – ACDF) before reduction. ---- [[Neck extension]] is likely to be relatively safe in injuries that are stable in [[flexion]] and [[extension]], such as [[odontoid fracture type II]] and [[cervical spine fracture]]s between C5 and C7. Head [[rotation]] is likely to be relatively safe in fractures below [[C4]], as well as [[cervical]] [[vertebral body]] fractures, and [[lamina]]r fractures without [[disc]] disruption. Early dialogue with the neurosurgical team remains a central tenet of the safe management of patients with combined [[maxillofacial]] and [[cervical spine injury]] ((Pepper T, Spiers H, Weller A, Schilling C. Intraoperative [[Position]]ing in [[Maxillofacial]] Trauma Patients With [[Cervical Spine Injury]] - Is It Safe? Radiological [[Simulation]] in a Healthy Volunteer. Craniomaxillofac Trauma Reconstr. 2022 Dec;15(4):312-317. doi: 10.1177/19433875211053091. Epub 2022 Jan 3. PMID: 36387322; PMCID: PMC9647385.)) ---- The current treatment recommendations according to the therapeutic recommendations of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU) as well as the S1 guidelines of the German Trauma Society (DGU) are presented. This second part of the article describes the correct indications and treatment planning for injuries to the cervical spine. Based on the AOSpine classification for subaxial cervical spine injuries, decisions can be made about conservative or surgical treatment as well as individual details of the treatment. The underlying principles of treatment are relief of neurological structures, restoration of stability, and reconstruction/preservation of the physiological alignment ((Schleicher P, Scholz M, Castein J, Kandziora F. Leitliniengerechte Therapie von Verletzungen der subaxialen Halswirbelsäule [Guideline-conform treatment of injuries to the subaxial cervical spine]. Unfallchirurg. 2021 Nov;124(11):931-944. German. doi: 10.1007/s00113-021-01087-3. Epub 2021 Sep 16. PMID: 34529103.)). ---- A study of Aciduman and Belen from [[Ankara]] University, [[Turkey]], presents information regarding the [[treatment]] of [[fracture]]s and [[dislocation]]s of the [[vertebra]]e, including the use of oral route for upper [[cervical fracture]]s, presented in certain chapters of the [[book]] titled Kitāb al-'Umda fī Ṣinā'a al-Jirāḥa (Ibn al-Quff, 13th century AD). A printed copy of the second volume of the book was studied. Chapters 22 ("On treatment of vertebral fractures") and 33 ("On treatment of vertebral dislocation") of the 17th treatise of this book were translated from Arabic into English. Each section is presented (in full text) in the Results section of this article. The findings were compared with the relevant [[literature]] and discussed to determine whether Ibn al-Quff presented novel information compared with that presented by his predecessors. The writings of Ibn al-Quff regarding vertebral [[dislocation]]s appear to summarize information derived from his predecessors. Moreover, he modified certain approaches, previously described for vertebral dislocations, and employed them for correcting [[vertebral fracture]]s. Ibn al-Quff introduced the most novel use of a bridle-like instrument for anterior [[cervical fracture]] through the oral route. By introducing the device in the mouth, he described a pushing maneuver to the cervical vertebrae from the ventral site and a simultaneous pulling maneuver by cupping on the neck from the dorsal site. The use of oral route introduced by Ibn al-Quff may be one of the earliest examples of novel, practical, and advanced [[cervical spine fracture treatment]] ((Aciduman A, Belen D. An early description of using oral route for the management of cervical vertebra fracture by Ibn al-Quff in the 13(th) Century. World Neurosurg. 2018 Sep 8. pii: S1878-8750(18)32025-4. doi: 10.1016/j.wneu.2018.09.005. [Epub ahead of print] Review. PubMed PMID: 30205224. )). ===== Cervical spine fracture surgery ===== [[Cervical spine fracture surgery]] ===== Subaxial cervical spine injury treatment ===== [[Subaxial cervical spine injury treatment]]