A Clinical Analysis of Traumatic Cervical Spine Injuries

Park, Seung Won; Park, Kwan; Kim, Young Baeg; Min, Byung Kook; Hwang, Sung Nam; Suk, Jong Sik; Choi, Duck Young

Abstract

Of eighty-two patients who were hospitalized for acute cervical injuries, seventy five lived, seven died within 5 months of injury, and one was lost to follow-up. These patients were grouped by injury mechanism, level of vertebral injury, level and type of cord injury, and management. Degree of injuries and prognosis were classified by modified Frankel's classification. The ratio of male to female was 3.3 to 1. The causes of traumas were traffic accidents, falling down, sports, diving, slip down. Traffic accident was the most common cause of trauma, and passenger injury was the most frequent cause among that. The most common level of dislocation was C5-6 followed by C4-5 level. The C5 vertebra was most commonly fractured. Injury mechanisms divided into 4 groups(compressive or disruptive flexion, compressive or disruptive extenstion. Disruptive extension was less common than other three groups. Vertebral fractures were more common in flexion mechanism than in the extension mechanism. Cord injuries were more common in the compressive injury groups than disruptive one. Spinal cord was frequently injured by compressive flexion mechanism(p<0.005). Complete cord injury was the most common type of cord injury. And complete cord injuries were most frequently ocured by compressive flexion mechanism(p<0.005). On the other hand, forty one cases of asymtomatic spinal column injuries were frequently seen in disruptive flexion mechanism group(p<0.005). Of twenty four patients were operated, forty one were fused posteriorly, one anteriorly, one was performed discectomy, and one was fused anteriorly and posteriorly. Operations were more frequently applied in the compressive mechanism groups(p<0.005). The rate of neurologic improvement was 76.2%, 91.3%, 73.9% and 75% in compressive flexion, disruptive flexion, compressive extension and disruptive extension group respectively. The rate of neurological improvement in the operated group was 83.3%, and 73.7% in the non-operated group. Common complications were urinary tract infection, pneumonia, bed sore, gastrointestinal bleeding. The more frequent complications were urinary tract infection and pneumonia. The rate of complications was more common when the initial neurologic status was worse(p<0.005). Expire rate was high in the compressive flexion mechanism group. When the initial neurologic statue was A, when cord injury was at C6 or higher levels. The most common cause of was pulmonary problem.