Subaxial cervical spine injury diagnosis
Initial evaluation
Due to the potentially catastrophic nature of cervical spine instability as a result of trauma, it is necessary to perform a meticulous and standardized clinical and radiographic evaluation. A patient with suspected cervical spine trauma should be evaluated and managed through the initial standardized approach as outlined by the Advanced Trauma Life Support algorithm and beginning with assessments of the airway, breathing, and circulation. Following this evaluation, if cervical spine injury is suspected, the neck should be protected as posterior cervical palpation proceeds to identify any tenderness or step-offs. In addition, inspecting a patient’s cervical posture for angular or rotational malalignments can hint to dislocations or subluxation. The upper torso, head, and neck can be evaluated for signs of trauma as this can hint to the type of force applied to the cervical spine during the trauma event. A patient should be log rolled while maintaining cervical spine stability to evaluate the entire spinal axis.
Details of the accident can lend helpful insight into the energy pattern to produce specific subaxial cervical spine trauma. Furthermore, it is important to identify other comorbid conditions that have a greater propensity for injury to the cervical spine such as previous cervical spine procedures, ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), or other connective tissue disorders leading to ligamentous hyperlaxity.
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.