Management of Cervical Spine Fractures and Injuries: A Literature Review

Abstract

Cervical spine injuries are one of the most common injuries of the spine that are encountered in the emergency department (ED). More than half of all spinal injuries presenting to the ED involve the cervical spine, with nearly half of them resulting from road traffic accidents. The majority of spinal cord injuries are found to occur in males of younger age groups, with almost half of them resulting in incomplete spinal cord injuries. The initial assessment of a patient with a suspected cervical spine fracture would include an Advanced Trauma Life Support (ATLS)-guided documented assessment of the patient involving a detailed, meticulous primary survey followed by a documented assessment of the patient through a secondary survey. Initial management of the cervical spine fracture begins at the scene of injury with prehospital care, which involves immobilisation of the cervical spine with "triple immobilisation" followed by initial airway management in the ED while maintaining in-line neck stabilisation, thereby minimising the neck movements. Neurological assessment according to the impairment scale and imaging in alert and stable patients is done based on established guidelines. However, a CT scan is the gold standard modality of imaging for suspected cervical spine fractures. All patients with a significant mechanism of injury must be assumed to have an unstable injury to their spine until proven otherwise according to British Orthopaedic Association Standard for Trauma (BOAST) guidelines.