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Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study.

Agrawal D, Sinha TP, Bhoi S - J Pediatr Neurosci (2015 Apr-Jun)

Bottom Line: This retro-prospective pilot study carried out over 1-month period (June-July 2013) after approval from the institutional ethics committee.The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz).C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting.

Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation.

Materials and methods: This retro-prospective pilot study carried out over 1-month period (June-July 2013) after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (≦18 years) with isolated severe head injury (Glasgow coma scale ≤8) coming to emergency department underwent an ultrasound examination.

Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5-C6 was seen in 4 patients and at C6-C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck.

Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable.

No MeSH data available.


Related in: MedlinePlus

Computed tomography cervical spine (sagittal section) and ultrasound image of the cervical spine of a patient with bilateral facet dislocation at C5–C6. The dislocation and disruption of the anterior longitudinal ligament is the cervical spine, is very well seen on ultrasound imaging (arrow)
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Figure 4: Computed tomography cervical spine (sagittal section) and ultrasound image of the cervical spine of a patient with bilateral facet dislocation at C5–C6. The dislocation and disruption of the anterior longitudinal ligament is the cervical spine, is very well seen on ultrasound imaging (arrow)

Mentions: After standardizing the ultrasound technique, ten admitted patients with documented cervical spine injury (on CT cervical spine) were evaluated with the same portable cervical ultrasound. Bilateral facet dislocation at C5–C6 was seen in four patients and at C6–C7 was seen in three patients. C5 burst fracture was present in one and C2 listhesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise, and ligamental injury in all cases [Figure 4].


Assessment of ultrasound as a diagnostic modality for detecting potentially unstable cervical spine fractures in pediatric severe traumatic brain injury: A feasibility study.

Agrawal D, Sinha TP, Bhoi S - J Pediatr Neurosci (2015 Apr-Jun)

Computed tomography cervical spine (sagittal section) and ultrasound image of the cervical spine of a patient with bilateral facet dislocation at C5–C6. The dislocation and disruption of the anterior longitudinal ligament is the cervical spine, is very well seen on ultrasound imaging (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4489052&req=5

Figure 4: Computed tomography cervical spine (sagittal section) and ultrasound image of the cervical spine of a patient with bilateral facet dislocation at C5–C6. The dislocation and disruption of the anterior longitudinal ligament is the cervical spine, is very well seen on ultrasound imaging (arrow)
Mentions: After standardizing the ultrasound technique, ten admitted patients with documented cervical spine injury (on CT cervical spine) were evaluated with the same portable cervical ultrasound. Bilateral facet dislocation at C5–C6 was seen in four patients and at C6–C7 was seen in three patients. C5 burst fracture was present in one and C2 listhesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise, and ligamental injury in all cases [Figure 4].

Bottom Line: This retro-prospective pilot study carried out over 1-month period (June-July 2013) after approval from the institutional ethics committee.The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz).C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, JPNA Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.

ABSTRACT

Background: Early cervical spine clearance is extremely important in unconscious trauma patients and may be difficult to achieve in emergency setting.

Objectives: The aim of this study was to assess the feasibility of standard portable ultrasound in detecting potentially unstable cervical spine injuries in severe traumatic brain injured (TBI) patients during initial resuscitation.

Materials and methods: This retro-prospective pilot study carried out over 1-month period (June-July 2013) after approval from the institutional ethics committee. Initially, the technique of cervical ultrasound was standardized by the authors and tested on ten admitted patients of cervical spine injury. To assess feasibility in the emergency setting, three hemodynamically stable pediatric patients (≦18 years) with isolated severe head injury (Glasgow coma scale ≤8) coming to emergency department underwent an ultrasound examination.

Results: The best window for the cervical spine was through the anterior triangle using the linear array probe (6-13 MHz). In the ten patients with documented cervical spine injury, bilateral facet dislocation at C5-C6 was seen in 4 patients and at C6-C7 was seen in 3 patients. C5 burst fracture was present in one and cervical vertebra (C2) anterolisthesis was seen in one patient. Cervical ultrasound could easily detect fracture lines, canal compromise and ligamental injury in all cases. Ultrasound examination of the cervical spine was possible in the emergency setting, even in unstable patients and could be done without moving the neck.

Conclusions: Cervical ultrasound may be a useful tool for detecting potentially unstable cervical spine injury in TBI patients, especially those who are hemodynamically unstable.

No MeSH data available.


Related in: MedlinePlus