Delayed post-traumatic cervical instability

BACKGROUND Cervical spine instability is a clinical entity whose biomechanical and rad iological features have been widely discussed by many authors. On the other hand, the subject of delayed post-traumatic cervical instability is often surrounded by confusion due to its difficult nosologic framing; the aim of this study is to contribute to the matter. METHODS A cooperative study was organized by the Study Group for Spinal Surgery of the Italian Society of Neurosurgery to evaluate cervical trauma patients su rgically treated more than 20 days after the traumatic event. From a total number of 172 patients, twenty-five were admitted to the study, because neu roradiological investigations performed during the acute phase had shown ei ther an absence of traumatic lesions or only minimal lesions judged to be s table. For this reason these 25 patients had not been treated by either sur gery or immobilization in a halo vest. Some time after trauma, this group o f patients clearly demonstrated evidence of unstable lesions requiring surg ical treatment, following the appearance of new clinical signs or on neuror adiological follow-up. RESULTS Re-examination of the neuroradiological investigations performed during the acute phase made it possible to identify elements that might have led us t o suspect the presence of ligamental lesions: microfractures, dislocations less than 3 mm, and inversion of physiological lordosis. CONCLUSIONS This review clearly indicates that patients with even mild cervical trauma must be scrupulously evaluated during the acute phase and that in some case s it is advisable to perform a more detailed neuroradiological investigatio n. (C) 1999 by Elsevier Science Inc.