Subaxial Cervical Spine Injuries in the Polytrauma Patient

Management of cervical spine injuries in polytrauma patients involves a comprehensive assessment that consists of a physical examination and imaging studies to identify substantial injury. The management of diagnosed cervical spine injuries in polytrauma patients should be coordinated with the management of other injuries. Timely management is required in polytrauma patients with a spinal cord injury. A high oxygen saturation level must be maintained and a mean arterial blood pressure of 85 mm Hg is recommended. Reduction via traction or urgent surgical decompression, as indicated, should be considered. Reduction that is performed within a few hours postinjury may reverse neurologic deficits, and decompression that is performed within 24 hours postinjury increases the likelihood of substantial recovery. Neuroprotection with the use of methylprednisolone is not recommended in polytrauma patients with a cervical spine injury. Early surgical treatment is safe in polytrauma patients with a cervical spine injury who are adequately resuscitated. The surgical approach is directed by the fracture type and the requirements for decompression. Anterior surgical approaches are preferred in polytrauma patients with a cervical spine injury, and definitive surgical treatment may be delayed.