Blunt neck trauma

Background

Three column concept of spinal fracture stability

• Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury
• Cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Workup

NEXUS Cervical Spine Rule

Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:

• No midline cervical tenderness
• No focal neuro deficits
• Normal alertness
• No intoxication
• No painful distracting injury

C-spine imaging should be considered unless the patient meets all of the above low risk criteria

^If find injury consider CT C-spine, x-ray rest of spine

Spinal cord trauma

• Neuro exam

Denver screening criteria for blunt cerebrovascular injury

The Denver Screening Criteria are divided into risk factors and signs and symptoms

Signs and Symptoms

• Arterial hemorrhage
• Cervical bruit
• Expanding neck hematoma
• Focal neurologic deficit
• Neuro exam inconsistent with head CT
• Stroke on head CT

Risk Factors

• Midface Fractures (Le Fort II or III)
• Basilar Skull Fracture with carotid canal involvement
• Diffuse axonal injury with GCS<6
• Cervical spine fracture
• Hanging with anoxic brain injury
• Seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status
  • Isolated seatbelt sign without other neurologic symptoms has not been identified as a risk factor

Management

• Prehospital
  • See the NAEMSP National Guidelines for Spinal Immobilization
• Hospital
  • See specific diagnosis

See Also

• Penetrating neck trauma

Source

• National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury. Facts and Figures at a Glance. Birmingham, Ala: NSCISC; July 1996
• Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. Am J Emerg Med. Oct 1997;15(6):591-5
• Woodring JH, Lee C, Duncan V. Transverse process fractures of the cervical vertebrae: are they insignificant? J Trauma. June 1993; 34(6):797-802.
• Tintinalli's