Prognosis and treatment of cervical spine injuries with associated head trauma

Pathological and biomechanical studies indicate that many injuries of the head and neck are to be considered as an entity, because cervical spinal fractures and head injuries are frequently combined. Depending on the localization and severity of the injury to the cervical spine, the incidence of an associated head trauma is reported in the literature as being between 6% and 63%. In 59 patients with cervical spinal fractures hospitalized in our department since 1980, we have examined the influence of head trauma on the prognosis and the management. Forty-three patients had fractures and/or dislocations in the lower cervical spine, and 16 had injuries in the upper region; head injuries were present in 33 (56 percent); minor injuries in 15, moderate and severe injuries in 10. Lesions requiring operation were a depressed skull fracture, extracerebral haematomas and scalp lacerations. Six out of 59 patients died; of these, four had suffered a severe head trauma. As a rule, surgery of the head and immobilization of the spine fracture were carried out as the first step followed by realignment of the spine with possible decompression and stabilization of the affected segment as a second step.

Fractures and/or dislocations of the cervical spine are frequently accompanied by head injuries. The severity of associated brain lesions has a marked influence on the prognosis. The correct identification of cervical lesions was delayed in about every second patient with minor head injury but rarely in comatose patients. In patients with altered consciousness an early spinal stabilization may be useful.