As a result, inflammation and swelling occur, causing discs to rip, project, herniate or depreciate. Histopathology is one of its five major interrelated components, and it occurs when a person’s body temperature rises due to an increase in lymph and blood supplies. This condition is characterized by a set of signs and symptoms that affect the spinal column. In patients with delayed symptoms, many have neurologic symptoms at the time of the injury, such as paresthesias or weakness, that have subsequently resolved.Following a car accident, the bones of the spine may shift out of their original position or lose their normal motion, in what’s called vertebral subluxation complex. However, up to 30 percent of patients have a delayed onset of neurologic abnormalities, which may not occur until up to four or five days after the injury. Paralysis may be present on the patient's arrival in the emergency department. 31 This situation may account for up to 70 percent of spinal cord injuries in children and is most common in children younger than eight years. As a result, the spinal cord also undergoes stretching, leading to neuronal injury or, in some cases, complete severing of the cord. SCIWORA syndrome occurs when the elastic ligaments of a child's neck stretch during trauma.
This situation has been named “SCIWORA” ( spinal cord injury with out radiographic abnormality) syndrome. In children, it is not uncommon for a spinal cord injury to show no radiographic abnormalities. Unilateral facet dislocations ( Figure 5)Īnterior dislocation of 25 to 33% of one cervical vertebra on lateral views an abrupt transition in rotation so that lateral view of affected vertebra is rotated lateral displacement of spinous process on anteroposterior viewįlexion, such as when picking up and throwing heavy loads (such as snow or clay)Īvulsion of posterior aspect of spinous process frequently an incidental findingĪ special situation involving children deserves mention. Large wedge off the anterior aspect of affected vertebra ligamentous instability causes alignment abnormalitiesĪnterior displacement of 50% or more of one cervical vertebra on lateral views Occurs with sudden deceleration (hanging) and with hyperextension, as in motor vehicle accidentsīilateral pedicle fracture of C2 with or without anterior subluxation lateral view required May be difficult to see on plain films high clinical suspicion requires CT scanning Occurs in patients with Down syndrome, rheumatoid arthritis and other destructive processesĪsymmetric lateral bodies on odontoid view, increased predental space Once an injury to the spinal cord is diagnosed, methylprednisolone should be administered as soon as possible in an attempt to limit neurologic injury.īurst fracture occurs with axial load or vertebral compressionĭisplaced lateral aspects of C1 on odontoid view, predental space more than 3 mm The “SCIWORA” syndrome (spinal cord injury without radiographic abnormality) is common in children.
Spine align table williams series#
The most common reason for a missed cervical spine injury is a cervical spine radiographic series that is technically inadequate. The lateral view must include all seven cervical vertebrae as well as the C7-T1 interspace, allowing visualization of the alignment of C7 and T1. Views required to radiographically exclude a cervical spine fracture include a posteroanterior view, a lateral view and an odontoid view. Significant cervical spine injury is very unlikely in a case of trauma if the patient has normal mental status (including no drug or alcohol use) and no neck pain, no tenderness on neck palpation, no neurologic signs or symptoms referable to the neck (such as numbness or weakness in the extremities), no other distracting injury and no history of loss of consciousness.
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