c-spine injury non-operative

c-spine injury non-operative - Cervical Spine Injuries...

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Cervical Spine Injuries Classification and Non-operative Treatment Dr. Heather Roche Dec. 12, 2002
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Evaluation MVA, diving accidents most common cause should suspect in anyone with head or high energy trauma or neurological deficit can be missed with multiple trauma and if non-contiguous vertebrae involved or altered consciousness 16% people will have non-contiguous spine fractures 50% will have other skeletal or visceral injuries
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History MVA thrown from car strike head any paralysis at time of injury if currently paralyzed was there any indication of movement at time of accident Physical full neuro exam including rectal and bulbocavernosus r/o other injuries
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Radiography Initial cross table lateral 70-79% AP and open mouth increases yield to 90-95% swimmer’s view for C7-T1 Other Ct scan bony anatomy and lower c-spine Flex-extension controversial in acute setting only in alert and cooperative patients without neurological deficit with neck pain false negatives due to muscle spasm
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MRI Patients with complete or incomplete neurulogical deficit, deterioration in neurological function or suspected posterior ligamentous injury despite negative plain radiographs
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Radiographic evidence of Instability Angulation between vertebral bodies that is 11 greater than adjacent segment AP translation > 3.5mm spinous process widening on lateral facet joint widening malalignment of spinous process on anterior view rotation of facets on lateral lateral tilting of vertebral body on anterior view
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Instability
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Initial Treatment Immobilization rigid cervical orthosis- Philadelphia collar unstable injury this is inadequate often and cervical traction required halo traction or gardner-wells tongs 1cm posterior to external auditory meatus and just above the pinna should be MRI compatible 10-15 pounds usually appropriate post alignment xray and neuro exam
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Closed Reduction Injuries demonstrating angulation, rotation or shortening restore normal alignment therefore decompressing the spinal canal and enhancing neuro recovery preventing further injury need neuro monitoring and radiography
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c-spine injury non-operative - Cervical Spine Injuries...

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