Class
Description
A
Complete: no motor or sensory preserved in sacral segments S4-5
B
Incomplete: sensory but no motor function preserved below neurologic level
C
Incomplete: motor function preserved below the neurologic level (more than half of key muscles below neurologic level have a muscle grade <3)
D
Incomplete: motor function preserved below the neurologic level (more than half of key muscles below the neurologic level have a grade equal to or greater than 3)
E
Normal: sensory and motor function normal
11.
Imaging:
(a)
X-rays of cervical spine, antero-posterior (AP) and lateral.
(b)
Computed tomography (CT) of cervical spine if injury is identified on X-rays or if they are inadequate.
(c)
Magnetic resonance imaging (MRI) of cervical spine is recommended if there is injury or neurologic deficit.
12.
Cervical spine clearance:
(a)
Requires both radiographic and clinical evaluation.
(b)
Radiographic clearance:
(i)
AP, lateral and open-mouth views.
(ii)
Must be able to visualize superior endplate of T1 for x-ray to be adequate; if not, CT is employed.
(iii)
Consider MRI of cervical spine if there imaging is positive for injury or if there is a neurologic deficit.
(c)
Clinical clearance:
(i)
Per the National Emergency X-radiography Utilization Study (NEXUS) criteria.
(ii)
No current or recent neurologic deficit.
(iii)
Awake patient with no distracting injury.
(iv)
No midline cervical tenderness to palpation and with full range of motion.
(v)
In obtunded patients, long term the cervical collar may lead to skin breakdown or interfere with patient care, in particular in patients with tracheostomy. Consider MRI of cervical spine within 72 h of injury.
13.
Fracture types:
(a)
Antlanto-occipital dislocation: twice as common in children than in adults due to ligamentous laxity; can be easily missed; maintain high index of suspicion; highly unstable; require surgical stabilization.
(b)
Atlanto-axial distraction: evaluate the symmetry of the C1-C2 facet joints and the atlanto-dens interval (ADI); some heal in a collar but most require surgery.
(i)
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Acceptable ADI:
1.
In children eight-years-old or less: < five mm.
2.
In older children and adults: < three mm.
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