[Therapeutic concept for injuries of the lower cervical spine]

Over a period of two and half years, the Spinal Surgery Working Group of the Deutsche Gesellschaft für Unfallchirurgie (German Association for Trauma Surgery) DGU has carried out a prospective study of relevant injuries of the cervical vertebral column in 544 patients. The lower section C3 to Th1 of the cervical vertebral column was affected in 308 cases (56 per cent). The injuries of the cervical vertebral column were caused primarily by accidents in road traffic and in the pursuit of recreational activities. More than half of the patients had multiple injuries. The share of degenerative concomitant changes as a cause for relevant injuries increased with age considerably. In case of a qualified trauma with the suspicion of an injury, the immobilisation of the cervical vertebral column has to be retained until the X-ray diagnosis inclusive of a computer tomography has been completed as this is obligatory for the clarification of suspected findings or for pre-operative planning, respectively. The diagnostic range is complemented by guided function imaging to reveal instabilities, and magnetic resonance imaging, which has to be carried out in case any X-ray pathology is absent and neurological functional deficit exists. Patients with neurological deficits, which were found in 43 per cent of the cases suffering from injuries of the lower cervical vertebral column, should be treated as quickly as possible with a high dose of methyl prednisolone. A recovery of the neurological abolition by at least one ASIA level was observed in 10 per cent of the patients concerned. A conservative therapy with a cervical collar was pursued in 24 per cent of the cases with stable injuries. An operative treatment indication, which was diagnosed in 76 per cent of the cases, aims at the early recovery of the anatomy with decompression of the spinal cord, reposition, and stabilisation of segments concerned. The point of the operation was determined by the neurological status, the existing dislocation, and the increasing instability as well as the concomitant injuries. Positioning necessary for intensive medical interventions required an early stabilisation of the spinal column. The front access with plate spondylodesis as a standard procedure with various special implants has proved to be safe and reliable in the healing result. Dorsal accesses shall remain reserved for definable individual indications and should be prevented in case of injuries of the cervical medulla, if possible, to spare the cervical muscles.