Search

Background: The pectoralis major musculocutaneous flap has been considered for decades the workhorse in head and neck reconstruction. However, the disadvantages of the pectoralis flap include the morbidity of the donor site in terms of cosmetic and functional results. A silicone pectoral implant can be used to solve such aesthetic chest deformity in male patients. Methods: A 33-years-old man with a history of cervical tracheoesophageal fistula after a blunt trauma due to a motorcycle accident, previously reconstructed with a pectoralis major flap, consulted our Plastic Surgery Department for an aesthetic defect of the donor site. The use of an anatomical pectoral implant was planned with the aim of aesthetic reshaping of the male chest. A pocket was created following the preoperative design to position a 190 cc pectoral implant. Dissection was performed in a subcutaneous plane that included the underneath adipose tissue layer and then over the pectoralis minor and the serratus muscle. Three months later, in a second stage, lipofilling of the depressed areas was performed with 100 ml of adipose tissue obtained from the abdomen. Results: After two years of follow-up, the patient obtained a satisfactory aesthetic result, with an improvement in the projection of the thorax and the symmetry of the body contour. As the implant was placed into the subcutaneous pocket, no functional compromise in shoulder flexion or adduction was detected during follow-up. Conclusions: The pectoral implant technique seems safe and provides reshaping of the male chest wall, significantly improving the cosmetic appearance of the patient. In addition, its use with associated procedures such as lipofilling allows optimal results to be obtained. To the best of our knowledge, this is the first case to describe the use of a pectoral implant to solve donor site morbidity after pectoralis flap harvesting for any reconstructive purpose. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Combined triple atlas (C1)-axis (C2) fixation has been described in previous literature as a safe, effective, and minimally invasive procedure for complex atlas and odontoid fractures that allows for a greater range of motion compared with posterior approaches and atlanto-occipital fusion. However, it is rarely performed due to the occipital-cervical diastasis resulting from often-fractured C1 joint masses. No evidence-based consensus has been reached regarding the treatment of complex atlantoaxial fractures, and the choice of surgical strategy is based only on clinical experience. We report the combined triple C1-C2 fixation technique with manual reduction of the joint masses during patient positioning on the operating table, which allowed for effective stabilization during a single surgical session. We describe our experience in the management of a 75-year-old patient presenting with an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. We provide a step-by-step guide for combined triple C1-C2 anterior fixation with manual fracture reduction and describe the clinical case of an acute complex type II fracture of C1, which also involved 1 lateral mass, combined with a type II odontoid fracture and occipital-cervical diastasis. Combined triple C1-C2 fixation represents a safe and efficient minimally invasive anterior approach for complex type II fractures of C1 with type II odontoid fractures. Manual reduction of the joint masses during patient positioning allows for effective stabilization in a single surgical session. [ABSTRACT FROM AUTHOR]

Objective: Previous research, including high-quality systematic reviews, has found that cervical injury, which often accompanies concussive head injury, can delay recovery from concussion. One pilot randomized controlled trial found that focused cervical assessment and appropriate intervention in children and young adults with persisting postconcussive symptoms (PPCS) improved recovery outcomes. Our sports medicine clinics adopted this approach early (within 2 weeks) in children (aged 10-18 years) after concussion. This study describes our clinical management protocol and compares the recovery trajectories in children after concussion with and without a concomitant cervical injury. Design: Prospective cohort study. Setting: Three university-affiliated outpatient sports medicine clinics from September 2016 to December 2019. Patients: One-hundred thirty-four concussed children with cervical impairment (mean age 14.9 years, 65% male, and 6.2 days since concussion) were compared with 130 concussed children without cervical impairment (mean age 14.9 years, 57% male, and 6.0 days since concussion). Independent Variables: Examination findings related to the cervical spine (range of motion, cervical spasm, and cervical tenderness). Main Outcome Measures: Recovery time (measured in days), concussion symptom burden (Postconcussion Symptom Scale), and incidence of PPCS. Results: Children with cervical impairment reported a higher initial symptom burden; however, there were no differences in recovery time (33.65 [28.20-39.09] days vs 35.98 [27.50-44.45] days, P = 0.651) or incidence of PPCS (40.0% vs 34.3%, P = 0.340). Conclusions: We conclude that within this pediatric population, early identification and management of cervical injuries concomitant with concussion may reduce the risk of delayed recovery. [ABSTRACT FROM AUTHOR]

Background: The halo fixation device introduces a significant obstacle for clinicians attempting to secure a definitive airway in trauma patients with cervical spine injuries. The authors sought to determine the airwayrelated mortality rate of adult trauma patients in halo fixation requiring endotracheal intubation. Methods: This study was a retrospective chart review of patients identified between 2007 and 2012. Only adult trauma patients who were intubated while in halo fixation were included in the study. Results: A total of 46 patients underwent 60 intubations while in halo. On five occasions, (8.3%) patients were unable to be intubated and required an emergent surgical airway. Two (4.4%) of the patients out of our study population died specifically due to airway complications. Elective intubations had a failure rate of 5.8% but had no related permanent morbidity or mortality. In contrast to that, 25% of non-elective intubations failed and resulted in the deaths of two patients. The association between mortality and non-elective intubations was statistically highly significant (P = 0.0003). Conclusion: The failed intubation and airway-related mortality rates of patients in halo fixation were substantial in this study. This finding suggests that the halo device itself may present a major obstacle in airway management. Therefore, heightened vigilance is appropriate for intubations of patients in halo fixation. [ABSTRACT FROM AUTHOR]

Analyzing human body movement is a critical aspect of biomechanical studies in road safety. While most studies have traditionally focused on assessing the head-neck system due to the restraint provided by seat belts, it is essential to examine the entire pelvis-thorax-head kinematic chain when these body regions are free to move. The absence of restraint systems is prevalent in public transport and is also being considered for future integration into autonomous vehicles operating at low speeds. This article presents an experimental study examining the movement of the pelvis, thorax and head of 18 passengers seated without seat belts during emergency braking in an autonomous bus. The movement was recorded using a video analysis system capturing 100 frames per second. Reflective markers were placed on the knee, pelvis, lumbar region, thorax, neck and head, enabling precise measurement of the movement of each body segment and the joints of the lumbar and cervical spine. Various kinematic variables, including angles, displacements, angular velocities and accelerations, were measured. The results delineate distinct phases of body movement during braking and elucidate the coordination and sequentiality of pelvis, thorax and head rotation. Additionally, the study reveals correlations between pelvic rotation, lumbar flexion, and vertical trunk movement, shedding light on their potential impact on neck compression. Notably, it is observed that the elevation of the C7 vertebra is more closely linked to pelvic tilt than lumbar flexion. Furthermore, the study identifies that the maximum angular acceleration of the head and the maximum tangential force occur during the trunk’s rebound against the seatback once the vehicle comes to a complete stop. However, these forces are found to be insufficient to cause neck injury. While this study serves as a preliminary investigation, its findings underscore the need to incorporate complete trunk kinematics, particularly of the pelvis, into braking and impact studies, rather than solely focusing on the head-neck system, as is common in most research endeavors.

Background: Magnetic resonance imaging (MRI) is a potential tool for the objective assessment of spinal cord injury (SCI) because it correlates well with the spatial and temporal extension of spinal cord pathology. This study aimed to systematically identify currently available scoring system based on MRI parameters, including measurement of the spinal cord lesion length in sagittal view (intramedullary lesion length (IMLL)) and morphology of the lesion in axial view (Brain and Spinal Injury Center (BASIC) score). Methods: A systematic search was conducted using the PubMed/MEDLINE database for English-language studies with the keywords “cervical,”“spinal cord injury,”“scoring system,”“scoring,”“classification,” and “magnetic resonance imaging” to systematically identify the scoring system based on MRI parameters. The main outcomes of interest are the scoring system's inter- and intraobserver reliabilities and its predictive accuracy of neurological outcome. Results: After assessing the full text and applying the inclusion and exclusion criteria, 13 articles were found to be eligible. The inter- and intraobserver reliabilities were rated as good until perfect for increased signal intensity (ISI), maximum canal compromise (MCC), maximum spinal cord compression (MSCC), BASIC score, cord-canal-area ratio, space available for the cord, and the compression ratio. The weighted mean difference of IML between the group with converted ASIA Impairment Scale (AIS) grade and the group without conversion is 31.79 (I2=93%, P=0.008). The percentage of agreement between the initial BASIC score of 4 with AIS grade of A at follow-up is 100%. Conclusions: Certain MRI parameters, including IML and BASIC score, have good reliability and correlate well with neurological outcome, making them candidates for building simple and objective scoring system for cervical SCI. Level of Evidence: 2A

Abstract Background Spinal cord injury (SCI) can cause considerable morbidity and mortality. Until now there is no spinal cord injury profile in Indonesia. Therefore, this study aims to provide an overview of the spinal cord injury profile as well as to analyze the functional outcome at the sixth month and the first year. Results Most spinal cord injury cases were traumatic SCI (67.5%). Meanwhile, non-traumatic SCI was 32.5%. The mean age of patients who had traumatic SCI was 41.9 ± 17.4 years while non-traumatic SCI patients was 48.4 ± 13.7 with a significant difference (p

Clinical Scenario: In wrestling, athletes often support a large amount of weight on their heads or are forced into extreme ranges of motion. These suboptimal movement conditions lead to a high prevalence of neck injuries in wrestlers. A large portion of the work done by the cervical musculature in wrestling is theorized to be eccentric or isometric types of contractions. Strengthening of these cervical muscles is clinically considered to play a vital role in being competitive on the wrestling mat. The cervical stability provided by strengthening these muscles may also play a part in injury prevention among wrestlers. Focused Clinical Question: Does increased cervical strength lead to a decreased risk of injury in wrestling? Summary of Search, "Best Evidence" Appraised, and Key Findings: The literature was searched for studies of level 4 evidence or higher using the Oxford Centre for Evidence-Based Medicine level of evidence system that investigated the relationship between cervical strength and injury risk in wrestling. No studies were found comparing cervical strength to injury risk in wrestling, but 2 related studies were found and have been included in this critically appraised topic. Clinical Bottom Line: There is poor evidence to support a relationship between cervical strength and injury risk in wrestling. Strength of Recommendation: There is grade C evidence to indicate that increased cervical strength decreases the risk of injury in wrestling. [ABSTRACT FROM AUTHOR]

Injuries inflicted by needlefish resemble stab wounds, resulting from the rapid and forceful jumping of needlefish jaws from the water's surface. Needlefish impalement on the neck and face are often fatal compared to body areas or extremities. This case report investigates a rare incident where a 50-year-old male tourist sustained a cervical injury from needlefish impalement during an inter-island cruise. A 50-year-old male experienced right neck pain due to accidental impalement by a needlefish. The initial extraction attempt at a local health center proved unsuccessful, necessitating subsequent surgical intervention. The procedure involved successful removal of the needlefish jaw, wound cleaning, and primary closure with a penrose drain. The patient was discharged on the third postoperative day, showing no neurological deficits or signs of infection during the four-week follow-up. Managing needlefish injuries parallels addressing stab wounds, with the treatment approach guided by the specific location of the injury. Zone III injuries in the neck may pose challenges in bleeding control, especially when involving the internal carotid artery. In this case, a diagnostic approach with computed tomography angiography confirmed vessel integrity, allowing for an exploration approach with an L-shaped skin incision. Penetrating injuries from needlefish can be life threatening. Treatment strategies must target the injured organ, with consideration of further imaging to assess vascular involvement. • Penetrating cervical injury from needlefish impalement • Management of penetrating cervical injury • Surgical extraction of the needlefish jaw • Delayed presentation and partial extraction [ABSTRACT FROM AUTHOR]

Background: Spinal cord injury (SCI) can cause considerable morbidity and mortality. Until now there is no spinal cord injury profile in Indonesia. Therefore, this study aims to provide an overview of the spinal cord injury profile as well as to analyze the functional outcome at the sixth month and the first year. Results: Most spinal cord injury cases were traumatic SCI (67.5%). Meanwhile, non-traumatic SCI was 32.5%. The mean age of patients who had traumatic SCI was 41.9 ± 17.4 years while non-traumatic SCI patients was 48.4 ± 13.7 with a significant difference (p < 0.05). Most cases occurred in men rather than women with significant differences based on the type of injury (p < 0.05). Traffic accidents were the most common cause of cervical injuries (47.1%). Surgery was the most common treatment modality in cervical injury cases (60.4%) with the posterior approach being the preferred approach in most operative measures (72.4%). Respiratory failure was the leading cause of death (48.9%). The mean LOS of patients with traumatic SCI was 28.8 ± 14.3 days while the mean LOS of non-traumatic SCI patients was 44.7 ± 28.7 with a significant difference (p < 0.05). There was significance difference between the initial outcome and after the sixth month to first year follow-up (p < 0.05). Conclusions: This study demonstrated the epidemiology and characteristics of spinal cord injury which mostly had a good neurological outcome. [ABSTRACT FROM AUTHOR]

Purpose: Odontoid process fractures can extend rostral into the C2 arch. We investigated the clinical impact of a concurrent fracture of the pars interarticularis on odontoid failure. To overcome the surgical challenges related to the morphology of these fractures, we describe a novel surgical strategy using atlantoaxial joint distraction arthrodesis. Methods: We conducted a single centre cohort study of 13 consecutive patients with odontoid fractures extending into the pars treated between June 2016 and June 2018. Criteria for a stable fibrous non-union were: Atlanto-Dens Interval (ADI) < 3 mm, Posterior Atlanto-Dens Interval (PADI) > 14 mm and lack of symptomatic motion at the fracture site. Atlantoaxial instability was defined as greater than 50% subluxation across the C1-C2 joint. Return to pre-injury performance status was considered a satisfactory clinical outcome. Results: The mean age of the patient population was 77.2 years (SD 11.9). The mean follow-up time was 15 months (SD 5.2). 69% had an associated atlantoaxial instability (P-value 0.0005). Cervical orthosis treatment was associated with a high non-union rate (70%) (P-value 0.04) although it did not affect the overall clinical outcome. 2 cases presented with cord compression were treated surgically with pars interarticularis osteotomy and atlantoaxial distraction arthrodesis. Conclusions: Odontoid fracture with extension into the pars interarticularis often present with atlantoaxial instability and may result in stable fibrous non-union if treated non-operatively. The C1–C2 segment can be stabilised with atlantoaxial distraction arthrodesis achieved through an osteotomy of the pars interarticularis. [ABSTRACT FROM AUTHOR]

Introduction: Activity-based therapies (ABTs) focus on activating the neuromuscular system below the level of spinal cord injury (SCI) promoting neuromuscular capacity. Case description: A 2 year 7 month old with history of prematurity at 29 weeks, neonatal epidural abscess, resultant cervical SCI, respiratory failure, and global developmental delays presented for enrollment in an outpatient activity-based therapy program. Upon presentation to this program, he required nighttime mechanical ventilation via tracheostomy and daytime suctioning. He could not perform any age-appropriate activities and was described by his mother as 'present', neither engaged nor attentive. During and after 7 months of participation in ABTs including locomotor training and neuromuscular electrical stimulation, the patient demonstrated unexpected changes in his respiratory status leading to ventilator weaning with concomitant improvements in head and trunk control, participation, development, and quality of life. Discussion: ABT was not only safe for a medically complex child, but also this intervention had a remarkable effect on unresolved respiratory capacity and a more widespread impact on other functions as well as development. A child with a chronic, severe SCI demonstrated positive and impactful improvements in health, functional status, and quality of life during an episode of ABT. [ABSTRACT FROM AUTHOR]

Analyzing human body movement is a critical aspect of biomechanical studies in road safety. While most studies have traditionally focused on assessing the head-neck system due to the restraint provided by seat belts, it is essential to examine the entire pelvis-thorax-head kinematic chain when these body regions are free to move. The absence of restraint systems is prevalent in public transport and is also being considered for future integration into autonomous vehicles operating at low speeds. This article presents an experimental study examining the movement of the pelvis, thorax and head of 18 passengers seated without seat belts during emergency braking in an autonomous bus. The movement was recorded using a video analysis system capturing 100 frames per second. Reflective markers were placed on the knee, pelvis, lumbar region, thorax, neck and head, enabling precise measurement of the movement of each body segment and the joints of the lumbar and cervical spine. Various kinematic variables, including angles, displacements, angular velocities and accelerations, were measured. The results delineate distinct phases of body movement during braking and elucidate the coordination and sequentiality of pelvis, thorax and head rotation. Additionally, the study reveals correlations between pelvic rotation, lumbar flexion, and vertical trunk movement, shedding light on their potential impact on neck compression. Notably, it is observed that the elevation of the C7 vertebra is more closely linked to pelvic tilt than lumbar flexion. Furthermore, the study identifies that the maximum angular acceleration of the head and the maximum tangential force occur during the trunk's rebound against the seatback once the vehicle comes to a complete stop. However, these forces are found to be insufficient to cause neck injury. While this study serves as a preliminary investigation, its findings underscore the need to incorporate complete trunk kinematics, particularly of the pelvis, into braking and impact studies, rather than solely focusing on the head-neck system, as is common in most research endeavors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Santos-Cuadros, Page del Pozo, Álvarez-Caldas and San Román García.)

Given the exponential availability of data in health centers and the massive sensorization that is expected, there is an increasing need to manage and analyze these data in an effective way. For this purpose, data mining (DM) and machine learning (ML) techniques would be helpful. However, due to the specific characteristics of the field of healthcare, a suitable DM and ML methodology adapted to these particularities is required. The applied methodology must structure the different stages needed for data-driven healthcare, from the acquisition of raw data to decision-making by clinicians, considering the specific requirements of this field. In this paper, we focus on a case study of cervical assessment, where the goal is to predict the potential presence of cervical pain in patients affected with whiplash diseases, which is important for example in insurance-related investigations. By analyzing in detail this case study in a real scenario, we show how taking care of those particularities enables the generation of reliable predictive models in the field of healthcare. Using a database of 302 samples, we have generated several predictive models, including logistic regression, support vector machines, k-nearest neighbors, gradient boosting, decision trees, random forest, and neural network algorithms. The results show that it is possible to reliably predict the presence of cervical pain (accuracy, precision, and recall above 90%). We expect that the procedure proposed to apply ML techniques in the field of healthcare will help technologists, researchers, and clinicians to create more objective systems that provide support to objectify the diagnosis, improve test treatment efficacy, and save resources. [ABSTRACT FROM AUTHOR]

Neck protective devices for motorcyclists have been introduced fairly recently but there is no standard method to evaluate their performance. The goal of this study is to compare the response of riders' necks to direct impacts on the helmet with and without such a device. We investigate three common types of cervical injury mechanisms i.e. hyperflexion, hyperextension and lateral bending using finite-element method. The rotational movement of the head with respect to the torso, the neck shearing and axial loads and the stress distribution throughout the cervical vertebrae show that using the investigated type of neck protective device, which is designed to restrain the head–neck motion, can in some cases increase the risk of neck injury. Hence, the design of such devices needs further study and their assessment requires the introduction of relevant standards of evaluation. [ABSTRACT FROM AUTHOR]

Penetrating neck trauma, though rare, carries a high morbidity and mortality risk if not recognized promptly, due to the presence of vital neurovascular and airway elements within a closed compartment. We describe the unique presentation of a high zone 1 anterior midline cervical stab injury with bilateral large pneumothoraces and extensive pneumomediastinum. Understanding the respiratory mechanics and a high clinical suspicion will help to recognize such complications of tracheobronchial injuries and their timely management is key to salvage of these patients. [ABSTRACT FROM AUTHOR]

Given the exponential availability of data in health centers and the massive sensorization that is expected, there is an increasing need to manage and analyze these data in an effective way. For this purpose, data mining (DM) and machine learning (ML) techniques would be helpful. However, due to the specific characteristics of the field of healthcare, a suitable DM and ML methodology adapted to these particularities is required. The applied methodology must structure the different stages needed for data-driven healthcare, from the acquisition of raw data to decision-making by clinicians, considering the specific requirements of this field. In this paper, we focus on a case study of cervical assessment, where the goal is to predict the potential presence of cervical pain in patients affected with whiplash diseases, which is important for example in insurance-related investigations. By analyzing in detail this case study in a real scenario, we show how taking care of those particularities enables the generation of reliable predictive models in the field of healthcare. Using a database of 302 samples, we have generated several predictive models, including logistic regression, support vector machines, k-nearest neighbors, gradient boosting, decision trees, random forest, and neural network algorithms. The results show that it is possible to reliably predict the presence of cervical pain (accuracy, precision, and recall above 90%). We expect that the procedure proposed to apply ML techniques in the field of healthcare will help technologists, researchers, and clinicians to create more objective systems that provide support to objectify the diagnosis, improve test treatment efficacy, and save resources.

Objective: To determine clinical outcome in patients with cervical injury after lateral mass screws fixation in a tertiary care hospital. Methods: This study included 88 patients, with cervical injury confirmed radiologically. Patients <12 or >70 years, with traumatic discs, cord compression without subluxation and previously operated on cervical spine were excluded from this study. All patients underwent fixation with lateral mass screws through posterior approach under fluoroscopic guidance. Frankel grading was used to assess the clinical status of these patients pre-operatively & post-operatively. Results: There were 60(68.18%) males and 28(31.8%) females. The ages varied from 18 to 55 years with a mean of 32 yrs ± 8 yrs. The most common level of injury was C5-C6 in 46(52%) patients. According to Frankel grading system, 35 (39.8%) patients were placed in Grade A, 15(17.05%) in Grade B, 22(25%) in Grade C, 12 (13.6%) in Grade D, four (4.5%) in Grade E on admission. Postoperatively, 16 (18.2%) patients were placed in Grade A, 23 (26.1%) in Grade B, eight (9.1%) in Grade C, nine (10.2%) in Grade D and 26(29.6%) patients in Grade E with an overall improvement in neurological function in 51(58%) and power in 37(42%) patients. The major complications encountered were respiratory infections in 10(11.36%) and wound infection in four (4.5%) while eight (9.1%) patients expired. Conclusion: Lateral mass screws technique is a safe and effective method for cervical fixation after proper reduction. [ABSTRACT FROM AUTHOR]

Traumatic injury to the brain and its vessels is a major part of medical practice across the world. Its management however has long historical origins, but those beginnings can still teach clinical practitioners about the basic care of an injured patient. We present a little known historical medical case that to this day provides an example of best practice management resulting in successful clinical outcome. Charles IV (1316-1378) was Holy Roman Emperor between 1347 and 1378. During his reign, he disappeared for four months and returned a disfigured hunchback. There has been considerable controversy as to the cause of both his physical change and disappearance. We propose the most likely cause is from an unfortunate consequence of his love of jousting. Despite the damage and management of the traumatic injury endured by Charles IV occurring over 600 years ago, there are still lessons of his clinical management relevant to this day. [ABSTRACT FROM AUTHOR]

An understanding of head injury mechanism has a major role in predicting the anatomical injury. Frontal depressed fracture occurs if a substantial force is applied to the head. In this case, the flexion and extension axis. Overflexion and over-extension movement was reported to have correlation with cervical injury. This study was to find out the correlation cervical injury and frontal depresses fracture in mild head injury cases. A retrospective analytic study was carried out, chi-square and Pearson correlation test were performed using records of patients consulted to Neurosurgery Department of Dr. Hasan Sadikin Hospital in January 2008–December 2009. There were 354 cases of mild head injury with 17 (4.8%) cases of frontal depressed fracture, 14 (3.9%) cervical injuries, included one with both. The cause of the trauma were riding motorcycle, fell from height, and blunt trauma to the head. The statistical analysis showed a significant correlation between cervical injury and frontal depressed fracture (p=0.000). There was no correlation between helmet utilization and risk of cervical injury (p=0.157). In conclusion, fracture in mild head injury cases is an indicator of cervical injury.

Background: A patient with a suspected cervical spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the spine board.Objectives: We sought to determine which centering adjustment best limits cervical spine movement and minimizes the chance for secondary injury.Methods: Using five lightly embalmed cadaveric specimens with a created global instability at C5-C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the spine board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5-C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral).Results: The nonuniform condition produced significantly less flexion-extension than the uniform condition (p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension (p = 0.015), lateral bending (p = 0.003), and axial rotation (p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral (p = 0.017), axial (p < 0.001), and anteroposterior (p = 0.006).Conclusions: Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical spine motion and may be the most helpful for minimizing secondary injury based on the study findings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the accompanied cervical injuries of the patients presenting to the emergency department (ED) because of penetrating, perforating or tangential cranial gunshot injuries (CGI). Material and Methods: The retrospective study included 137 patients that presented to the EDs at Mustafa Kemal and Ataturk University due to penetrating, perforating or tangential CGI between 2014 and 2018. Patients younger than 12 years old and had insufficient radiological records were excluded from the study and thus 115 patients were included in the study. Results: 115 patients included 105 (91%) men and 10 (9%) women with a mean age of 27 (range, 12-65) years. Of the 115 injuries, 84 (73%) were high-velocity and 31 (27%) were low-velocity gunshot injuries. The injuries included 92 (80%) penetrating or perforating and 23 (20%) tangential injuries. No cervical dislocation injury was accompanied by CGI in any patient. Unilateral lamina fracture of the cervical vertebra was observed in one patient. Conclusion: Our results support the opinion that isolated penetrating, perforating or tangential CGI did not cause to cervical spinal injuries, the intubation or tracheostomy procedures should not be postponed after radiological evaluation of cervical spinal stability. [ABSTRACT FROM AUTHOR]

Abstract Traumatic subdural hematomas (SDHs) in the posterior fossa in conjunction with cervical spinal hematomas are rare entities. In this case, we present a 22-year old man who presented to our institution with ligamentous injury at the cervicomedullary junction, associated with posterior fossa SDH not discovered initially, who on serial computed tomography scans was found to have symptomatic obstructive hydrocephalus and was successfully treated with SDH evacuation and stabilization of the cervicomedullary junction with instrumentation.

A 59-year-old man with a history of chronic ankylosing spondylitis for many years, developed neck pain and left cervico-brachial neuralgia following a road traffic accident sustained one week before. Plain radiographs of cervical spine were initially misinterpreted. On examination, he had severe neck pain on mobilization without any neurological deficits. Delayed cervical computed tomography scan showed ossification of the anterior longitudinal ligament, calcification of the intervertebral discs and complete vertebral fusion (so called bamboo spine) with transversal fracture at C5-C6 disc level (so called carrot-stick fracture) causing a luxation of the cervical spine with significant compromise in canal space (A and B). A transcranial spinal traction was performed followed by anterior decompression and stabilization via an anterolateral cervical approach. The outcome was favourable. Transverse fractures of the spine are rare in patients with ankylosing spondylitis and diagnosis should be considered following even minor trauma. These atypical unstable fractures occur because of the loss of flexibility and fragility of the osteoporotic spine. Early diagnosis for possible intervention is important because of the high mortality rate.

Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting. Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation. Materials and Methods: This retro-prospective pilot study carried out over 1-month period (June-July 2013) after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (≦18 years) with isolated severe head injury (Glasgow coma scale ≤ 8) coming to emergency department underwent an ultrasound examination. Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5-C6 was seen in 4 patients and at C6-C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck. Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable. [ABSTRACT FROM AUTHOR]

Background Early cervical spine clearance is extremely important in patients with head injuries and may be difficult to achieve in emergency setting. This is especially true in hemodynamically unstable unconscious patients and in low-resource settings. This study aimed to assess the feasibility of standard portable ultrasound in detecting cervical spine injuries in severe head-injured patients. Materials and Methods This retro-prospective pilot study performed over 1-month period (June-July 2013) after approval from the institutional ethics committee. During the study period the technique of cervical ultrasound was standardized by the authors and tested on 10 admitted patients of cervical spine injury. To assess feasibility in the emergency setting, hemodynamically stable patients with isolated severe head injury (GCS ≤8) coming to emergency department underwent ultrasound examination on a portable ultrasound machine (MicroMaxx, Sonosite Inc., Bothell, Washington, United States). Observations and Results Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck. The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz). In the 10 patients with documented cervical spine injury, bilateral facet dislocation at C5-6 was seen in four patients and at C6-7 was seen in three patients. C5 burst fracture was present in one and C2 anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise, and ligament injury in all cases. Conclusion Cervical ultrasound may be a useful tool for detecting cervical spine injury in unconscious patients, especially those who are hemodynamically unstable. It may be particularly useful in the resource-constrained setting of developing countries [ABSTRACT FROM AUTHOR]