Cases reported "Spinal Injuries"

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11/34. Isolated fracture of the medial portion of the lateral mass of the atlas: a previously undescribed entity.

    Four cases of fracture of the medial aspect of the lateral mass of the atlas are presented. Unlike most cases of atlantal fracture, definite history of a blow to the vertex could not be established. While the exact mechanism of injury is unknown, it is postulated that the bone fragment is produced by a combination of stretching the ligamentum transversarium and pressure on the lateral mass due to contraction of the neck muscles. All four patients were neurologically intact and complained of pain in the distribution of the greater occipital nerve. It is suggested that this fracture might be identified more often in patients with similar histories and complaints by use of laminagraphy, since part or all of the atlas is frequently obscured on routine open mouth roentgenograms of the upper cervical spine.
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12/34. Acute traumatic cervical epidural hematoma from a stab wound.

    Cervical spinal epidural hematoma is an infrequent entity that usually requires emergency decompressive therapy because of rapid neurologic dysfunction. We present the case of a 34-year-old man who presented to the emergency department with minimal symptomatology after a stab wound to the neck. A computed tomography myelogram of the cervical spine revealed a cervical spinal epidural hematoma. This case illustrates an unusual presentation as well as etiology of cervical spinal epidural hematoma.
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13/34. Vascular insufficiency of the cervical cord due to hyperextension of the spine.

    A patient with acute transverse myelopathy after minor trauma due to hyperextension of the neck is reported. The pattern of neurologic deficit favors the diagnosis of acute central cervical spinal cord syndrome. The proposed causative mechanism is temporary vascular insufficiency of the spinal cord. The architecture of vascular supply of the spinal cord and specific cerebrospinal fluid abnormalities in this patient are compatible with the diagnosis. The differential diagnosis of traumatic vascular spinal cord lesions is discussed.
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14/34. incidence and diagnosis of C7-T1 fractures and subluxations in multiple-trauma patients: evaluation of the advanced trauma life support guidelines.

    A 5-year retrospective review was done to evaluate C-7 and C7-T1 cervical spine injuries and to assess the advanced trauma life support guidelines for cervical spine evaluation. Eighteen fractures of C-7 and four fracture-dislocation at C7-T1 were identified. Nineteen of the patients had neck pain, tenderness, or neurologic findings on initial examination. Three patients were awake and asymptomatic. The initial diagnosis could be made from lateral cervical spine x-ray film in only three of the 22 patients. In the remaining patients, the diagnosis was made by either swimmer's view (7 of 8 positive), oblique views (1 of 1 positive), flexion-extension views (2 of 3 positive), or computed tomography (CT) scan (7 of 7 positive). In two patients, the diagnosis was not made in the first 24 hours. Follow-up x-ray films were positive in 3 of 22 lateral cervical spine films, 10 of 14 swimmer's views, 2 of 3 oblique views, 2 of 3 flexion-extension views, and 14 of 20 CT scans. The data support the advanced trauma life support recommendation for liberal use of cervical spine radiologic screening. We recommend that the screening examination consist of a lateral cervical spine film, and a swimmer's view, if necessary, to visualize C-7 and the C7-T1 interspace. We further recommend that strong consideration be given to the use of a five-view trauma series. CT scan should be viewed as complementary to conventional film techniques.
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15/34. Sudden death of a young wrestler during competition.

    The circumstances of the sudden death of a young healthy wrestler in the course of a wrestling match are described. The death occurred due to acute ischemia of the brainstem as a result of the acute interruption of blood flow to his vertebral-basal system, as a consequence of the injury or rupture of vertebral arteries, after injury of the neck. This interruption of the irrigation of the brainstem with blood provoked the sudden death of the athlete. The cause of the injury to the neck of the wrestler was the wrong position of his head (it was trapped between the mat and his own forearm), at the moment when the athlete was in the inferior disadvantaged position and his opponent was exerting a powerful but permissible effort to overthrow him. The combination of the wrong position of the head of the injured athlete and the forceful action of the wrestler in the offensive resulted in the overflexion and rotation of the head of the former and the (inevitable) damaging of his neck. Various predisposing factors effectively contribute to the injury, the main ones being the lack of warming up of the athlete, the premature fatigue of the athlete, minor injuries at the cervical segment of the vertebral column during the phases preceding the main injury, and the confrontation with an opponent of greater training age and superior fighting level. The only way to deal with similar, very rare indeed, incidents is to implement the set of preventive measures described.
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16/34. An unusual presentation of bilateral facet dislocation of the cervical spine.

    We report the case of a patient who presented complaining of neck pain after a fall. Initial physical examination was remarkable for an occipital scalp contusion and tenderness to palpation in the mid-cervical spine. Neurological examination demonstrated an absence of response to pinprick below approximately the T4 level. Upper extremities had equal withdrawal to pain and lower extremities were without movement. Initial cervical, thoracic, and lumbar spine films were normal. An emergency myelogram demonstrated a complete extradural block at the C6 level. Cross-table lateral cervical spine films revealed a C5-C6 bilateral facet dislocation. The patient subsequently underwent closed reduction with in-line-traction. He had a prolonged hospital course and was eventually transferred for rehabilitation, with some improvement in neurologic status.
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17/34. Occipito-atlantal instability in children. A report of five cases and review of the literature.

    We are reporting the cases of five patients who had occipito-atlantal instability, a rare condition that may be due to either trauma or congenital abnormalities. In three of the patients the instability was secondary to trauma. The clinical and neurological manifestations were varied and included cardiorespiratory arrest, motor weakness, quadriplegia, torticollis, pain in the neck, vertigo, and projectile vomiting. All of the patients underwent posterior arthrodesis of the occiput to the first or second cervical vertebra. In the patients who had trauma-related instability, surgery was performed when immobilization in a cast failed to stabilize the spine; in the patients who had a congenital abnormality, arthrodesis was indicated because of persistent symptoms and the potential for catastrophe with minor trauma. Based on our experience, we recommend surgical stabilization by posterior arthrodesis when this form of instability of the cervical spine is diagnosed.
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18/34. spine problems in emergency department patients: does every patient need an x-ray?

    Two hundred adults with spine problems were evaluated by one examiner in a community hospital emergency department. A patient was considered to have a spine problem requiring evaluation if presenting with pain in the neck or back not obviously caused by a process outside of the spine (eg, back pain in a patient with renal colic); if there was known or suspected trauma to the neck or back; or if the clinical setting suggested spinal tumor, infection, metabolic bone disease, or ankylosing spondylitis. Of the 200 patients, 143 were studied by x-ray films. Six patients (6 of 143, or 4%) had x-ray abnormalities that mandated specific treatment. Fifty-two of the 57 patients not receiving x-ray studies were followed up at 2 months. Thirty-three of these patients (63%) had no x-ray studies in the interim and had improved greatly. Nineteen (37%) had been studied radiographically in the interim, but no abnormality requiring specific treatment was found in any patient. Emergency physicians should be aware that x-ray studies of the spine have low utility for patients whose histories and examinations are benign, that especially for women lumbosacral x-ray studies involve high gonadal radiation exposure, and that selected patients can be managed without x-ray studies and still be satisfied recipients of adequate medical care.
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19/34. Displacement of the spinolaminar line--a sign of value in fractures of the upper cervical spine.

    The spinolaminar line is an important anatomical landmark easily visualized on the lateral radiograph of the cervical spine. Any displacement in this line may be an indication of subtle traumatic vertebral damage. This is particularly relevant to the upper cervical spine in which the complex anatomy and frequent absence of associated neurological deficit make diagnosis difficult. Two case histories are presented which emphasize the importance of evaluation of the spinolaminar line on the lateral radiograph after trauma to the head and neck.
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20/34. spinal injuries in belt-wearing car occupants killed by head-on collisions.

    In 34 post-mortem examinations of car occupants wearing seat belts and killed in straight or oblique head-on collisions, a thorough investigation of the spine was performed. The autopsy results were correlated with the findings in the cars in order to reconstruct the events when the occupant's body struck the interior of the car. In 2 cases the victims had worn lap belts, in 15 cases shoulder belts and in 17 cases combined shoulder-lap belts (three-point belts). In victims involved in head-on collisions while wearing lap belts, fractures of the neural arch of the axis were found which were probably due to flexion of the neck pivoting round the lower part of the impacting face and simultaneous stretching of the neck. Severe injuries to the cervical spine in those victims wearing shoulder belts were mainly due to the occupant sliding under the belt which then caught the neck and mandible. Such injuries were also caused by the impact of the head against forward parts of the car. In those wearing shoulder-lap belts injuries to the upper part of the cervical spine resulted from the impact of the head against internal parts of the car. When a slight impact of the head occurred minor injuries to the lower cervical spine were seen. Injuries to the thoracolumbar spine in the cases examined were the consequence of a violent extension between the upper part of the trunk held back by the shoulder belt and the pelvis restrained by the lap belt or by the knees striking the fascia panel. In front seat occupants this extension can be increased if either rear seat occupants without belts or heavy objects on the rear seat are projected forwards against their backs.
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