47 Box 34-4 describes recommendations for airway management in the patient with a suspected or known cervical spine injury.ĭerek A Woessner MD, Charles W Webb DO, FAAFP, in The Sports Medicine Resource Manual, 2008 Radiographic testingĬervical spine injuries are common for those participating in athletic events, from the “weekend warrior” to the well-conditioned athlete (10% of the 10,000 cervical spine injuries that occur annually in the United States are in individuals participating in athletic activities).
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A higher incidence of cervical spine limitation and difficult intubation may exist among elderly patients. Evidence shows that some degree of cervical spine motion occurs with all methods of intubation, 45,46 but data are lacking about whether the small amount of movement that occurs during airway management is clinically significant. No one method of intubation has been proved to be safest, and rapid-sequence intubation by direct laryngoscopy is the most commonly reported technique.
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If necessary, the collar may be removed for airway management, provided that manual in-line stabilization is maintained. The presence of a cervical collar increases the difficulty of intubation. Manual in-line stabilization of the cervical spine is recommended for airway management in patients with a suspected or known cervical spine injury to reduce the potential for neck movement. Significant head injury is associated with traumatic cervical spine injury patients with a Glasgow Coma Scale score of 8 or less often require emergent airway management. 43 Most trauma patients are placed in a cervical collar until cervical injury is ruled out some of these patients may require CPR and emergent airway management before a radiologic examination can be obtained. 42 If the anterior and posterior columns of the cervical spine are injured, the injury is considered unstable. Berkow, in Benumof and Hagberg's Airway Management, 2013 B Cervical Spine InjuryĬervical spine injury has been diagnosed in 2% to 5% of patients after traumatic injury. Current pharmacologic treatment is concerned with minimizing the deleterious effects of secondary injury. Also, primary cervical spinal cord injury leads to altered autonomic tone, loss of autoregulation, depressed cardiovascular function, and hypotension. A biochemical cascade that destabilizes the neurologic axon membrane and promotes vasospasm creates a secondary injury pattern after the initial insult. Transmission of this energy results in microhemorrhage in the spinal cord central gray matter and loss of neurotransmission in the surrounding white matter.
![cervical spine cervical spine](http://cdn1.bigcommerce.com/server3900/8be44/products/2148/images/3134/ceevical__18912__45356.1319052550.1280.1280.jpg)
The spinal cord is injured when the ligaments, muscles, and osseous structures fail to dissipate the energy of impact. The cervical spinal cord is particularly prone to injury because of spinal flexibility and the mass of the head. Ĭervical spine injuries in children younger than 2 years are exclusively C1-C2 injuries, because facet joints at this level are more horizontal and the ligaments more lax.Young children are less susceptible to cervical spine injury because they weigh less and have more cartilage than adults do vulnerability increases with age. Motor vehicle accidents and sports-related activities account for the majority of cervical spine injuries in younger patients, whereas falls account for most cervical spine injuries in older patients. Most cervical spine injuries result from motor vehicle accidents (42% to 56%), falls (19% to 30%), or gunshots and sports-related activities (6% to 7%). The highest prevalence is in 15- to 24-year-old males, with a smaller peak occurring in persons older than 55 years.
![cervical spine cervical spine](https://i.ytimg.com/vi/tqrHBEXtKn0/maxresdefault.jpg)
The peak distribution of injury is at the C2 and C5-C6 levels. Īpproximately 50% of cervical spine movement occurs at the upper cervical spine.Ĭervical spine injuries occur in 1.5% to 7.7% of all major trauma cases.These injuries can often be divided into upper cervical injuries (occiput, atlas, axis), lower cervical injuries (C3-C7), neurapraxia (“stingers” and “burners”) ( Figure 59-1), and transient quadriplegia. Preventing activities that apply axial load to the cervical spine, such as in “spearing” (which is banned), is a far more effective means of prevention. Protective equipment may not prevent cervical injuries. The neck is at greatest risk when the lordotic curve is straightened, at approximately 30 degrees of flexion, because of its diminished ability to disperse axial load forces. Normally, the cervical spine dissipates much of the forces experienced through the paravertebral muscles, intervertebral discs, and normal lordosis of the spine. They most commonly occur in sports resulting in excessive axial loads applied to the head that transmit forces through the cervical spine. Cervical spine injuries in sports are uncommon but can produce significant disability.