Introduction: The Canadian C-Spine rule (CCR) was validated for use by paramedics to selectively immobilize stable trauma patients. However, the CCR “Dangerous Mechanism” is highly prevalent in sports. Our objective was to compare the CCR performance in sport-related vs. non-sport-related injuries and describe sport-related mechanisms of injury. Methods: We reviewed data from the prospective paramedic CCR validation and implementation studies in 7 Canadian cities, which already included identification of sport-related injuries. A single trained reviewer further categorized mechanisms of injury using a pilot-tested standardized form, with the aid of a sport medicine physician in 15 ambiguous cases. We compared the CCR's recommendation to immobilize sport-injured versus non-sport-injured patients using chi-square and relative risk statistics with 95% confidence intervals. Results: There were 201 amateur sport-injuries among the 5,978 patients. Sport-injured patients were younger (mean age 36.2 vs. 42.4) and more predominantly male (60.5% vs 46.8%) than non-sport-injured patients. Paramedics did not miss any c-spine injuries when using the CCR. Although cervical spine injury rates were similar between sport (2/201; 1.0%) and non-sport injured patients (47/5,777; 0.8%), the absolute number of sport-related injuries was very small. Although CCR recommended immobilization equally between the two groups (46.4% vs 42.5% p = 0.29; RR 1.17 95%CI 0.87-1.57), the reason for immobilization was more likely to be a dangerous mechanism in sport injuries (68.6% vs 54.5%, p = 0.012). Although we observed a wide range of mechanisms, the most common dangerous mechanism responsible for immobilization in sport was axial load. Conclusion: The CCR identified all significant c-spine injuries in a cohort of patients assessed and transported by paramedics. Although an equal proportion of sport and non-sports related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the CCR to evaluate all sport-related injuries in collegiate or pro athletes evaluated by sport medicine therapists and physicians, as these patients are rarely assessed by paramedics or transported to a hospital. It does support the safety and benefit of using the CCR in sport-injured patients for which paramedics are called.

Introduction: Unnecessary imaging of adult cervical spine (C-spine) injury patients in the Emergency Department (ED) is a concern. Guidance for C-spine image ordering exists; however, the effectiveness and safety of their implementation in the ED is not well studied. This review examines their implementation and effectiveness at reducing C-spine imaging in adults presenting to the ED with stable neck trauma. Methods: Six electronic databases and the grey literature were searched. Comparative studies examining interventions to reduce C-spine imaging were eligible for inclusion. Two independent reviewers screened for study eligibility, assessed study quality, and extracted data. Data were analyzed using RevMan (Version 5.3) to explore the effectiveness of these interventions in safely reducing C-Spine radiography. Results: A total of 848 unique citations were screened of which six before-after studies and one randomized controlled trial were included. The study population varied with respect to injury severity (i.e., stability status). None of the studies were assessed as high quality. The interventions employed included locally developed guidelines and clinical decision rules, specifically the National X-radiography Utilization Study (NEXUS) criteria and the Canadian C-Spine Rule (CCR). Various implementation strategies, such as teaching sessions, pocket reminder cards, posters and computerized decision support were used. Several studies used multi-faceted interventions. Overall, of the five study groups that examined change in x-ray ordering, three groups reported a significant reduction in c-spine radiography. The remaining two showed no change in imaging. A pooled estimate of the effectiveness of the interventions was prohibited by significant heterogeneity. Conclusion: The evidence regarding the effectiveness of interventions to reduce C-spine imaging in adult ED patients with stable neck trauma is inconclusive. Given the national and international focus on improving appropriateness and reducing unnecessary imaging through campaigns such as Choosing Wisely®, additional interventional research in this field is warranted.

Cervical muscles are crucial in providing the stability of the cervical spine. Many in vitro studies have investigated the relationship between muscle force and stability directly. However, the effects of different muscle dysfunctions or muscle recruitments on cervical spine stability are not yet clear and therefore, worthy of study. A spine testing apparatus with muscle force replication activated by pneumatic cylinders was developed to find the effect of muscles on spinal stability. Seven porcine cervical spines (C2-T1) were used. Three pairs of cervical muscles, including neck flexors (sternocleidomastoid, SCM) and neck extensors (splenius capitis, SPL; semispinalis capitis, SSC), were simulated. The experimental tests included: 1. no muscle recruitment, 2. full muscle recruitments, 3. SCM dysfunction, 4. SPL dysfunction, and 5. SSC dysfunction. The external pure moment in sagittal plane was applied from 0 Nm to 2 Nm to examine the stability/flexibility of specimens. The spinal stability was evaluated by the neutral zone (NZ), the range of motion (ROM), the reduced NZ (R_NZ), and the reduced ROM (R_ROM). Loading responses of C7-T1 disc were also measured. The results of this study showed: The activation of cervical muscles decreased the NZ and ROM. The degree of decrease among different muscle dysfunctions, however, was not significantly different. The SPL dysfunction induced larger anterior shear force, while the SCM dysfunction exclusively induced extension moment. In conclusion, the muscle forces could stabilize the cervical spine, but significant decrease in spinal stability was not found among dysfunctions of different muscles. The SCM and SPL dysfunction may result in abnormal stress at the C7-T1 disc.

Purpose: In 2001 an evaluative study was conducted involving an oral positioning aid (the E-Z-Em Mouthpiece). Manufacturer opinion suggested that the device may enhance safe and demonstrative practice in the radiographic and radiological components of case examinations involving acute trauma to the upper cervical spine. The study was conducted at Auckland Public and Starship Children's Hospitals, New Zealand with prior approval from Auckland Health Research Human Subjects Ethics Committee.

Literature review confirms that the atlanto-axial compartment of the cervical spine is most commonly involved in acute cervical spine injury. Consequently difficulty experienced in achieving adequate and optimal radiographic demonstration of the osseous and articular structures of this complex region is well reported.

Methods: The study adopted applied programme evaluation – methodology. The evaluation was conducted within a time frame stipulated by the ethics approval. All participating subjects presented with a case history of trauma to the cervical spine referred for initial radiological assessment from either accident and emergency or admission departments. Radiographers who performed the examinations were requested to use the positioning device. When the examination was concluded, questionnaire participation was requested to provide reports from each examination. These reports were then subjected to analysis.

Results: Seventy-five patients participated in the study. Thirty-three questionnaires were completed (a respondent rate of 44%). Responses tended to endorse provision of the device for optional use within current examination practice. Factors influencing optional use of the device were difficulties associated with subject type, the position of external immobilising collars, peripheral injuries sustained by the patient and difficulty experienced with those subjects who had suffered multiple injuries with associated head injury.

Conclusions: This study supports provision for the availability and optional use of this product in certain cases, supporting the manufacturer's assessment of its capability to enhance aspects of image quality and assist subject immobilisation.

The authors present the case of an 11-year-old boy with a painful, rapidly expanding lesion in the posterior triangle of the neck. There was no history of cervical trauma. Computerized tomography of the neck revealed a unicameral (single-chambered) aneurysmal bone cyst involving the C3 vertebra. Treatment was by open resection and curettage; no recurrence was seen at six months. We discuss the natural history, differential diagnosis, radiographic appearance and treatment modalities for this unusual, benign, expanding, osteolytic lesion containing blood-filled cystic cavities.

a 49-year-old man with cervical osteomyelitis and right hemiparesis treated surgically was presented. mri at 2 weeks after the onset revealed a disc bulging at c5/6, whereas those at 4 weeks showed spinal cord compression and surrounding abscess formation. drastic destructive features progressed between 2 and 4 weeks after the onset. repeated mri investigation using fat suppression technique or gadolinium enhancement will be necessary for a difficult diagnostic vertebral osteomyelitis.

A 17-year-old victim of a road traffic accident presented. Following investigation diagnoses of fractured first cervical vertebra, aortic transection, diffuse cerebral oedema, fractured right ribs 2–4 and pubic rami were made. Management of this case presented a number of anaesthetic dilemmas: management of the airway, use of cross-clamp vs. shunting or heparinization and bypass, cardiovascular and neurological monitoring, maintenance of cardiovascular stability during and post cross-clamp, minimizing the risk of post-operative renal and neurological dysfunction.

Serial transverse histological sections of the human craniovertebral junction (CVJ) of 4 normal human embryos (aged 45 to 58 d) and of a fetus (77 d) were used to create 3-dimensional computer models of the CVJ. The main components modelled included the chondrified basioccipital, atlas and axis, notochord, the vertebrobasilar complex and the spinal cord. Chondrification of the component parts of CVJ had already begun at 45 d (Stage 18). The odontoid process appeared to develop from a short eminence of the axis forming a third occipital condyle with the caudal end of the basioccipital. The cartilaginous anterior arch of C1 appeared at 50–53 d (Stages 20–21). Neural arches of C1 and C2 showed gradual closure, but there was still a wide posterior spina bifida in the oldest reconstructed specimen (77 d fetus). The position of the notochord was constant throughout. The normal course of the vertebral arteries was already established and the chondrified vertebral foramina showed progressive closure. The findings confirm that the odontoid process is not derived solely from the centrum of C1 and that there is a ‘natural basilar invagination’ of C2 during normal embryonic development. On the basis of the observed shape and developmental pattern of structures of the cartilaginous human CVJ, we suggest that certain pathologies are likely to originate during the chondrification phase of development.

Prehospital guidelines that define the clinical indications for spine trauma also serve as the criteria for selective spinal immobilization in the field. Therefore, these criteria are important for avoiding further spinal cord damage. Because some spine injuries may occur without neurological deficits or other clinical signs, the recommended field guidelines extend beyond the signs and symptoms and include mechanisms of injury or other injuries commonly associated with a high risk of spine injury.