Abstract
Acute neck pain in the sports setting can occur with any and all sports, including practice and game situations. Understanding the guidelines for examination and initial treatment and management is integral for a good outcome. Knowing the types of injuries that can occur at each spinal level can also help in the immediate care of the injured athlete.
Keywords
cervical spine injury, neck pain, NEXUS criteria
1
In what environment do spinal cord injuries occur most often and what percentage of those injuries involve the cervical spine?
The majority of spinal cord injuries are a direct result of motor vehicle accidents (MVA) (47%), falls from heights (23%), gunshot wounds/violence (14%), and sports-related activities (9%). Of these acquired spinal injuries the cervical spine accounts for 65% of MVAs, 53% of falls from heights, 37% of gunshot/violence, and 97% of diving injuries (diving is a subset of sports-related activities).
2
When approaching a patient with a suspected acute cervical spine injury, what should the primary survey consist of?
First, check ABCDEs and determine if lifesaving maneuvers are needed. If patient is in stable condition, maintain inline immobilization until cervical spine is cleared.
A – Airway: Establish and/or maintain an open airway via the jaw thrust maneuver (jaw thrust generates less cervical spine motion than the head tilt/chin lift).
B – Breathing: Ensure the patient is breathing (look, listen, and feel for signs of breathing). If absent, rescue breathing may be needed.
C – Circulation: Locate a palpable pulse. If absent, CPR may be needed.
D – Disability: Identify level of consciousness by utilizing the Glasgow Coma Scale.
E – Exposure: Remove clothing when necessary.
3
What findings indicate cervical spine immobilization?
Based upon the Canadian C-Spine Rule, if the patient is >65 years old, if the patient had a dangerous mechanism of injury (fall >3 feet, axial load to head, MVA >100 km/hr, motorcycle/bicycle collision), or if there is paresthesia in the extremities, then immobilization is indicated. Additionally, if the patient was involved in a simple rear-end MVA, is sitting or standing independently at any time, has delayed onset of neck pain, or has no midline C-spine tenderness, then range of motion can be safely assessed. If the patient is unable to actively rotate the neck 45 degrees left and right, then immobilization is indicated. Once immobilized the patient should be transported for imaging (100% sensitivity, 42.5% specificity).
The National Emergency X-Radiography Utilization Study (NEXUS) can be used to determine low-risk patients who do not require immobilization and imaging. If there is no midline tenderness, no focal neurologic deficit, normal alertness, no intoxication, and no painful distracting injuries, then the patient does not require immobilization and imaging (99.6% sensitivity, 12.9% specificity).
4
What is the optimal method of immobilization for clinically significant acute cervical spine injuries?
The most stable form of biomechanical immobilization is obtained through the use of a rigid cervical collar, rigid spine board, and head immobilization once on the board. The inclusion of strapping furthers the biomechanical immobilization of the thoracolumbar spine.
5
Which imaging modality should be utilized when assessing acute cervical spine injuries?
In adults and adolescents computed tomography (CT) scans should be utilized as the initial imaging modality of choice due to superior sensitivity and specificity. If unavailable, radiographs can be utilized (anterior-posterior, lateral, atlantoaxial views). Radiographs should be used for children to limit radiation exposure.
6
What are some commonly seen upper cervical spine (C1–C2) injuries?
See Table 29.1 .
| Mechanism of Spinal Injury | Stability |
|---|---|
| Flexion | |
| Flexion teardrop fracture | Extremely unstable |
| Bilateral facet dislocation | Always unstable |
| Atlantooccipital dislocation | Unstable |
| Anterior atlantoaxial dislocation with/without fracture | Unstable |
| Odontoid fracture with lateral displacement fracture | Unstable |
| Subluxation | Potentially unstable |
| Wedge fracture | Stable |
| Transverse process fracture | Stable |
| Clay shoveler’s fracture | Stable |
| Flexion-Rotation | |
|---|---|
| Rotary atlantoaxial dislocation | Unstable |
| Unilateral facet dislocation | Stable |
| Extension | |
|---|---|
| Posterior neural arch fracture (C1) | Unstable |
| Hangman fracture (C2) | Unstable |
| Posterior atlantoaxial dislocation with/without fracture | Unstable |
| Extension teardrop fracture | Usually stable in extension |
| Compression | |
|---|---|
| Jefferson fracture (C1) | Extremely unstable |
| Burst fracture of vertebral body | Stable |
| Isolated fracture of articular pillar and vertebral body | Stable |
7
What are some commonly seen lower cervical spine (C3–C7) injuries?
See Table 29.2 .
| Mechanism of Injury | Stability |
|---|---|
| Flexion | |
| Bilateral facet dislocation | Extremely unstable |
| Flexion teardrop fracture | Unstable |
| Posterior ligamentous injury | Severe = unstable; mild = stable |
| Wedge fracture | Stable |
| Compression fracture | Stable |
| Clay shoveler’s fracture | Stable |
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