Chapter 30 The Neck and Spine

The vertebral column is composed of a series of motion segments. A motion segment consists of two adjacent vertebrae, their intervertebral disc and ligamentous restraints. Upper cervical spine anatomy is designed to facilitate motion, and stability here is dependent on ligamentous restraints. Spinal stability is the ability of the spine to withstand physiological loads with acceptable pain, avoiding progressive deformity or neurological deficit. The spine can be divided into three columns: anterior, middle and posterior. The primary survey always takes precedence, followed by a careful systems examination paying particular attention to the abdomen and chest. Spinal cord injury may mask signs of intra-abdominal injury. A full cervical spine series includes anteroposterior and lateral radiographs of the whole cervical spine, and open mouth views. Computed tomography scanning with two-dimensional reconstruction remains the gold standard in spinal trauma and is indicated for patients with suspected or visible injuries on plain radiographs.

Multiple Choice Questions
Weblinks

Journal articles

https://journals.lww.com/spinejournal/Abstract/1983/11000/The_Three_Column_Spine_and_Its_Significance_in_the.3.aspx/ (paid)

This paper details the three-column classification of spinal trauma. First described by Denis for thoracolumbar fractures, it is still commonly used in surgical practice to predict if a spinal fracture is stable or unstable. The classification is applicable for spinal fractures from C3 to L5 (not just thoracolumbar fractures).

https://journals.lww.com/spinejournal/Fulltext/2010/10011/Early_Versus_Late_Stabilization_of_the_Spine_in.6.aspx/ (free)

This is a systematic review investigating the benefits of early versus late fixation in patients with unstable fractures and normal neurology. The review indicates that early fixation is beneficial, leading to shorter hospital and intensive care unit stay and a reduction in complications. The advantage was greatest in patients with high injury severity scores (polytrauma).

Guidelines

https://www.mascip.co.uk/wp-content/uploads/2016/10/Advice-for-Acute-Centres-on-Acute-SCI-in-Adults.pdf (free)

This document details the initial management of a patient with an acute spinal cord injury. It presents algorithms as guidelines for the early management and recognition of possible complications.

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