Management Head & Cervical

Injury
Abdurrahman Mouza
 ATLS
• A : Airway + Cervical Collar
• B : Breathing + Thorax + Saturasi
• C : TD + Abdomen
• D : GCS + Pupil
• E : Eksposure
 GCS
E M V
4 6 5
3 5 4
2 4 3
1 3 2
2 1
1
 Clinical Evaluation Cervical

 Proper Immobilization

 Assume a spine injury with head or neck

trauma

 3 to 25% of spinal cord injuries occur after

initial traumatic episode.
 Asymptomatic Trauma Patient

• Cervical x-rays not required in patients

without tenderness and are alert.

Trauma Patients with Neck Pain

• 2 to 6% incidence of significant spine

injuries.
 Do Not Remove Collar Until

 Absence of tenderness

 Absence of pain

 Normal mental status

 complete radiographic evaluation

 Most Common Missed Diagnosis

• Occipitoathlantoaxial region or cervicothoracic

junction

• Plain x-ray will miss 15 to 17% of injuries

 CAT scan has 99% predictive value

 MRI better for soft tissue, may be oversensitive

• A doctor qualified to interpret these films must
review the complete series of cervical spine
radiographs before the spine is considered
normal.
• Do not remove the cervical collar until a
neurologic assessment and evaluation of the c-
spine, including palpation of the spine with
voluntary movement in all planes, have been
performed and found to be unconcerning or
without injury.
Approximately 10% of patients with a cervical
spine fracture have a second, noncontiguous
vertebral column fracture.
 Nonsurgical Care

 P.T. – emphasize isometric exercise

 Traction with slight flexion

 Medication

 Epidural steroids
 Surgical Indications

• Success for axial pain is 60 %

• Success for radiculopathy is 90%

• Disk Replacement – evolving technology

 ACDF

• Allograft versus autograft

• Plate fixation

• Accelerates degeneration at adjacent levels

 Posterior Decompression

• Foraminotomy for bony foraminal stenosis

• Laminectomy – risk of kyphosis

• Laminectomy – decompression without

adding fusion
Thank you