cervical spine compromise

most common area of c spine injury

C2, C5, C6, and C7

• Bone integrity increases as you move distally through the spine

  
  

direction of c spine injuries

Flexion

Extension

Rotation

Lateral bending

Distraction (stretching)

Compression (axial loading)

axial loading

• slight forwad flexion

• subsequent force to the top of the head

• teach: “heads up” “see your opponent”

pathophysiologic processes that may occur after spinal cord injury

•Initial trauma

•vasogenic edema

•altered blood flow

spinal cord injuries should always be expected if…

• patient unconscious

• axial neck pain

• evidence of neuroligic injury

absence of neurologic findings

• does NOT eliminate possibility of spinal cord injury

physical examination

• Muscle strength grading

• sensation

• eliciting deep tendon reflexes for both the upper and lower extremities

• Evaluating any tenderness, range of motion, and crepitus

  
  

cervical evaluation

• stabilize

• apply advanced trauma life support protocols

once stable

• radiographs: AP, lateral, oblique and odontoid

(all of c spine and c7-t1 space)

National Emergency X-Radiography Utilization Study (NEXUS) Criteria

imaging is indicated if the patient exhibits

• Midline Tenderness 

• Focal Neurologic Deficit

• Altered Level of Consciousness

• Intoxication

• Distracting Injury

Canadian C-Spine Rule step 1

radiographs should be obtained based on the following algorithm

Step 1: High-Risk Factors mandating radiography:

• Age older than 65 years

• Dangerous mechanism

• Paraesthesia in extremities

If yes, the patient is at risk for cervical injury, if no, proceed to step two

Canadian C-Spine Rule step 2

Low-Risk factors indicate a safe assessment of a range of motion

• Simple rear-end motor vehicle collision

• Patient ambulatory at any time since the injury

• Delayed onset of neck pain

• Patient in sitting position

• Absence of midline cervical tendernes

If no low-risk factors present, radiography indicated, otherwise proceed to step three

Canadian C-Spine Rule step 3

• Is the patient able to actively rotate neck 45 degrees to left and right?

• If yes, radiography not indicated. If no, the patient is at risk for cervical injury, radiography indicated

  
  

when not to image

•Absence of posterior midline cervical tenderness

•A normal level of alertness

•No evidence of intoxication

•No abnormal neurologic findi ngs

•No painful ‘distracting’ injuries

occipital-cervical spine injuries or ‘upper cervical’ injuries

Injuries from the occiput to C2

sub-axial cervical spine injuries

C3 through C7 fractures

wedge fracture

Compression of the anterior vertebrae

• hyperflexion injury

Burst fractures

vertebrae seems to ‘explode’

• Results from axial loading

Atlanto-occipital dislocation

flexion injury involving the skull and C1

Atlanto-axial dislocation

flexion-rotation injury involving C1 and C2

Jefferson fractures

Unstable C1 fracture due to compression

Stable Injuries

• Minimal risk of further displacement

• e.g., minor compression fractures, sprains, or isolated spinous process fractures

  
  

Unstable Injuries

• Risk of progression or neurological damage

• e.g., bilateral facet dislocations, burst fractures with spinal canal compromise

Allen-Ferguson Classification

Only for subaxial injuries, C3–C7

Vertical Compression

Compressive Flexion

Distractive Flexion

Compressive Extension

Distractive Extension

Lateral Flexion

Compressive Flexion

Wedge or teardrop fractures

Vertical Compression

Burst fractures

Distractive Flexion

Facet dislocations or subluxations

Compressive Extension

Posterior element fractures or laminar fractures

Distractive Extension

Ligamentous disruptions or anterior longitudinal ligament tears

Lateral Flexion

Asymmetric injuries from side bending

American Spinal Injury Association (ASIA) Impairment Scale

classifies the severity of a spinal cord injury

ASIA A

Complete; patient has no motor/sensory function below injury level

ASIA B

Incomplete; sensory but no motor function preserved

ASIA C

Incomplete; motor function preserved, most key muscles <3/5 strength

ASIA D

Incomplete; most key muscles ≥3/5 strength

ASIA E

Normal motor and sensory function

C1 Fracture (i.e. ‘Jefferson fracture’)

Classified by number of fracture sites (1–4) and stability (stable vs. unstable)

type I jefferson fx

• axial load and flexion or extension

• isolated fx of A/P arch

type II jefferson fx

• axial load

• bilateral fx of A/P arch

type III jefferson’s fx

• axial and rotation

• lateral mass fx

atlanto - occipital dislocation

• axial load and rotation

• distraction and hyperextension or hyperflexion of atlanto - occipital jt

• severe disruption of ligaments btwm base of skull and atlas

C2 Fracture

odontoid fx

hangmans fx

type I odontoid fx

Avulsion of odontoid tip (stable)

type II odontoid fx

Fracture at odontoid base (unstable)

type III odontoid

Fracture extending into C2 body (variable stability)

type I hangman’s fx

Minimal displacement, no angulation (stable)

type II hangman’s hangman’s fx

Significant displacement and angulation (unstable)

type IIA

Minimal displacement, significant angulation (unstable)

type III hangman’s fx

Displacement with facet dislocation (highly unstable)

c spine stabilization

manually stabilized by grasping the mastoid processes bilaterally with the fingertips while cupping the occiput in the hands

• thumbs are pointed toward the face of the injured athlete

contraindications for moving the cervical spine to neutral

•the movement causes or increases pain, neurologic symptoms, or muscle spasm

•the movement would compromise the airway

•it is physically difficult to perform the movement

•resistance is encountered during the attempt to realign the cervical spine

•the patient expresses apprehension

removal of equipment

should be deferred until the athlete has been transported EXCEPT

• if the helmet is not properly fitted to prevent movement of the head independent of the helmet

• if the equipment prevents neutral alignment of the cervical spine or airway access

• “all or nothing”

face mask removal

• if they interfere with the ability to access the airway should be completely removed from the helmet

• should be initiated once the decision to immobilize and transport has been made

combined tool approach

• if facemask screw removal is impossible with powered screwdriver use a backup cutting tool

football helmet reconditioning and recertification

at least every two years, annual recommended

helmet lifespan

10 yrs, per NAERA

football helmet reconditioning process

• inspection

• cleaning and sanitizing

• repainting

• repair/replacement

• recertification

helmet inspection

inspected for damage and wear, including the shell, liner, and other components

helmet cleaning and sanitizing

should be thoroughly cleaned and sanitized to remove dirt, sweat, and bacteria

helmet repainting

• optional

• sanded and repainted with a fresh coat of paint

helmet repair and replacement

Any damaged or worn parts will be repaired or replaced with new OEM parts

helmet recertification

ensure helmet meets NOCSAE standards and is safe for use