eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Cervical Spine: Treatment & Medication

Author: Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Contributor Information and Disclosures

Updated: Oct 30, 2009

Treatment

Prehospital Care

When a cervical spine injury is suspected, minimize neck movement during transport to the treating facility. Ideally, transport the patient on a backboard with a semirigid collar, with the neck stabilized on the sides of the head with sand bags or foam blocks taped from side to side (of the board), across the forehead.

Emergency Department Care

  • If spinal malalignment is identified, place the patient in skeletal traction with tongs as soon as possible (with very few exceptions), even if no evidence of neurologic deficit exists.
  • The specific injury involved and capabilities of the consulting staff guide further management.
  • Place tongs 1 finger width above the ear lobes in alignment with the external auditory canal.
  • The consultant applies the tongs for traction under close neurologic and radiograph surveillance.

Consultations

  • An orthopedic surgeon or neurosurgeon, depending on local availability, custom, or referral system, should be available for immediate referral.
  • If the treating physician notes spinal cord injury, consult a neurosurgeon.

Medication

Administer steroids to any patient with blunt cervical spine injury and associated neurologic symptoms of less than 8 hours in onset.

Corticosteroids

Agents have anti-inflammatory properties and cause profound, varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli.


Methylprednisolone (Solu-Medrol, Depo-Medrol)

Decrease inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability.

Adult

30 mg/kg IV q30min; followed by continuous IV drip 5.4 mg/kg q1h for 1 d

Pediatric

Administer as in adults

Coadministration with digoxin, may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels of methylprednisolone; phenobarbital, phenytoin, and rifampin may decrease levels of methylprednisolone (adjust dose); monitor patients for hypokalemia when they are taking medication concurrently with diuretics

Documented hypersensitivity; viral, fungal, or tubercular skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use

More on Fracture, Cervical Spine

Overview: Fracture, Cervical Spine
Differential Diagnoses & Workup: Fracture, Cervical Spine
Treatment & Medication: Fracture, Cervical Spine
Follow-up: Fracture, Cervical Spine
Multimedia: Fracture, Cervical Spine
References
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References

  1. Trafton PG. Spinal cord injuries. Surg Clin North Am. Feb 1982;62(1):61-72. [Medline].

  2. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. Dec 25 2003;349(26):2510-8. [Medline]. [Full Text].

  3. Mulkens TH, Marchal P, Daineffe S, Salgado R, Bellinck P, te Rijdt B, et al. Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma. AJNR Am J Neuroradiol. Sep 2007;28(8):1444-50. [Medline].

  4. Winslow JE 3rd, Hensberry R, Bozeman WP, Hill KD, Miller PR. Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma. Sep 2006;61(3):686-7. [Medline].

  5. Davidson JSD, Birdsell DC. Cervical spine injury in patients with facial skeletal trauma. J Trauma. 1989;29:1276-1278. [Medline].

  6. O'Malley KF, Ross SE. The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma. Oct 1988;28(10):1476-8. [Medline].

  7. Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med. Mar-Apr 1988;6(2):109-12. [Medline].

  8. Hills MW, Deane SA. Head injury and facial injury: is there an increased risk of cervical spine injury?. J Trauma. Apr 1993;34(4):549-53; discussion 553-4. [Medline].

  9. Duane TM, Dechert T, Wolfe LG, Aboutanos MB, Malhotra AK, Ivatury RR. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma. Jun 2007;62(6):1405-8; discussion 1408-10. [Medline].

  10. Ellis GL. Imaging of the atlas (C1) and axis (C2). Emerg Med Clin North Am. Nov 1991;9(4):719-32. [Medline].

  11. Hockberger RS, Kirshebaum KJ, Doris PE. Spinal injuries. In: Rosen P, Barkin R, Danzl DF, et al, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby-Year Book; 1998:462-503.

  12. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. Jul 13 2000;343(2):94-9. [Medline].

  13. Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. Am J Emerg Med. Oct 1997;15(6):591-5. [Medline].

  14. Jacobs LM, Schwartz R. Prospective analysis of acute cervical spine injury: a methodology to predict injury. Ann Emerg Med. Jan 1986;15(1):44-9. [Medline].

  15. Mahoney BD. Spinal injuries. In: Tintinalli JE, Krone RL, Ruiz E, eds. Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw Hill Text; 1996:1147-1153.

  16. National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury. Facts and Figures at a Glance. Birmingham, Ala: NSCISC; July 1996.

  17. Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, et al. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. Feb 15 2008;33(4 Suppl):S101-22. [Medline].

  18. Proudfoot J, Pollack E, Friedland LR. Pediatric cervical spine injury: navigating the nuances and minimizing complications. Pediatr Emerg Med Rep. 1996;1(9):83-94.

  19. Roberge RJ, Wears RC, Kelly M, et al. Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma. Jun 1988;28(6):784-8. [Medline].

  20. Stassen NA, Williams VA, Gestring ML, et al. Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. J Trauma. Jan 2006;60(1):171-7. [Medline].

  21. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. Oct 17 2001;286(15):1841-8. [Medline].

  22. Velmahos GC, Theodorou D, Tatevossian R, et al. Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing. J Trauma. May 1996;40(5):768-74. [Medline].

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Further Reading

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Keywords

cervical spine fractures, cervical spine injuries, cervical vertebrae, odontoid fractures, atlanto-occipital dislocation, simple wedge fracture, flexion teardrop fracture, bilateral facet dislocation, clay shoveler fracture, unilateral facet dislocation, rotary atlantoaxial dislocation, hangman fracture, extension teardrop fracture, posterior neural arch fracture, Jefferson fracture, burst fracture, atlas fractures, atlantoaxial subluxation, occipital condyle fracturecentral cord syndrome, fracture of the posterior arch of C1, pillar fracture, anterior cord syndrome, fracture of transverse process of C2, upper cervical spine injuries, occiput to C2 injuries, cervical orthosis, neurogenic shock

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Contributor Information and Disclosures

Author

Moira Davenport, MD, Attending Physician, Departments of Emergency Medicine and Orthopedic Surgery, Allegheny General Hospital
Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Mark Louden, MD, FACEP, Assistant Medical Director, Emergency Department, Duke Raleigh Hospital
Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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