Wednesday, May 6, 2020
Cervical Spine and Soft Tissue Underlying Injury
Question: Discuss about the Cervical Spine and Soft Tissue Underlying Injury. Answer: Further, in emergency care department misalignment is identifies and taken care off followed by consultation management. The radiographic surveillance is followed by surgery and medication as per requirements of injury. The most basic forms of medications are muscle relaxants and Non-steroidal anti-inflammatory drugs (NSAIDs) that control inflammatory response and pain of injury. The consultation process includes consultation from surgeon and neurosurgeon about post-treatment management processes as per injury (3,6). Condition/Pathological process/Medical Significance The Disruption to the lines of alignment of the cervical spine and soft tissue underlying injury is the clinical conditions that generally arise due to fractures (C5/C6), flexion injuries (hyperflexion), extension injuries, axial compression injuries and unstable fractures in the cervical region. There are four major regions anterior vertebral line, posterior vertebral line, spino-laminar line and posterior spinous line covered by smooth tissues that provide support to the overall structure of the cervical region. Any kind of disruption due to fracture, injury that leads to a major dislocation on the cervical spine region produces these conditions. Some of the most common injuries are (anterior subluxation) where rupturing of posterior ligament occurs, (simple wedge fracture) here the anterior ligament fractures, (wedge fracture) damage to both anterior and posterior ligaments, (flexion teadrop fracture) leads to axial loading cord damage. Further, the extension injuries lead to breakage in ligaments, and axial compression injuries like Jefferson fracture leads to rupturing of C1 ring (1,2) Pathological Process and Medical Significance The alignment of cervical spine damages leads to neurological damages in more than 40% cases. Further, this condition leads to nerve root dysfunction, the upper region cervical spine subluxation complexes leads to complicated neurovascular situations. Further, these disruptions also hinder the functionality of vertebral veins, cerebrospinal circulation, cervical veins, vagus nerve, and medulla oblongata. Any kind of depression or derived mobility of any one cervical spine segment leads to disturbance in spinal nerve area circulation because artery and vein supplying spinal nerve pass through this region (2). Further, (3) studied that any kind of cervical injury leading to muscle spasm result in circulatory impairment where different kinds of cardiac, cranial nerve, vagal, extrapyramidal and auditory symptoms appear as secondary symptoms. There are irritation in vertebral arteries producing vasomotor nature like facial pain, headache, facial flushing, nasal disturbance etc. There are chances of venous drainage resulting in passive congestion and pressure on sensory nerves. Further, there are disturbances in the medulla oblongata region also due to cervical injuries. Imaging Procedures Employed to Evaluate the Pathology The plain films or X-ray is the easiest employed process of pathology identification in 80% cases of cervical spine injuries. The mostly performed X-ray includes lateral view, AP view and odontoid view (open-mouth). The lateral radiograph is the first and foremost detection process of cervical spine injuries. However, the AP view and odontoid view are performed in the case of no obvious fractures observed in lateral view. In this radiograph, patient needs to maintain the cervical immobilisation until the repeated radiographs are obtained and viewable. Lastly, in the case of no fracture or injury identified by above three plain radiographs then flexion and extension radiographs are employed to detect possible injury (4,5). (4) indicated that CT scan is generally employed for cervical injuries detection when plain radiography fails to detect the injuries and clinical symptoms still exist. The CT scan are specifically useful for detection of neurologic defects, cervical canal fractures etc. further, MRI procedures are followed in case of soft tissues, intervertebral disks, ligaments, spinal cord and epidural injuries. Radiologic Features The radiographic features of disruption to the lines of alignment of the cervical spine and soft tissue underlying injury get generally visualised in the lateral radiograph. The occurrence of any disruption will lead to defects in anterior vertebral, posterior vertebral and spinolaminar region. The increase in soft tissue retropharyngeal region is observed as the outcome of haemorrhage or oedema occurring due to fractures or dislocation. In the case of wedge-compression fractures, there is a difference in anterior and posterior height (increase or decrease) of vertebral body observed as the radiographic feature. In children pseudodosubluxation at C2/C3 region leads to the posterior step of more than 2mm occurring because of ligaments laxity. Further, the radiologic features of the condition in AP radiograph involve unilateral facet joint dislocation in case of bifid in spinous processes. Further, in the case of anterior cervical dislocation there is a wider distance between spinous processes. Lastly, in open mouth radiograph, there are damages in C1 and C2 region due to fractures where the lateral masses of C1 overhang C2 indicating burst fracture. Further, there is Mach effect observed due to mimicking of fractures in case of artefacts (4,5). Treatment Options The Disruption to the lines of alignment of the cervical spine and soft tissue underlying injury require prehospital, emergency department and consultation treatments as well as management. As prehospital care in case of suspected injury neck movements support facility. Stabilise the patient with backboard semirigid collar where the neck is stabilised with foam blocks or sand bags taped side to side of the backboard across the forehead. References Caron T, Bransford R, Nguyen Q, Agel J, Chapman J, Bellabarba C. Spine fractures in patients with ankylosing spinal disorders. Spine. 2010 May 15;35(11):E458-64. https://www.firstlightwebdesign.com/ H. The Cervical Spine. Imageinterpretation.co.uk. 2016 [cited 26 August 2016]. Available from: https://www.imageinterpretation.co.uk/cervical.php Imaging of the Cervical Spine. Med-ed.virginia.edu. 2016 [cited 26 August 2016]. Available from: https://www.med-ed.virginia.edu/courses/rad/cspine/technique7.html The Radiology Assistant : Spine - Cervical injury. Radiologyassistant.nl. 2016 [cited 26 August 2016]. Available from: https://www.radiologyassistant.nl/en/p49021535146c5/spine-cervical-injury.html X-ray Skills 2: Cervical Spine X-ray Interpretation. Calsprogram.org. 2016 [cited 26 August 2016]. Available from: https://calsprogram.org/manual/volume2/Section10_XraySkills/03-XraySk2CerSpineXrayInterp13.html Schroeder GD, Kwon BK, Eck JC, Savage JW, Hsu WK, Patel AA. Survey of cervical spine research society members on the use of high-dose steroids for acute spinal cord injuries. Spine. 2014 May 20;39(12):971-7.