Therapeutical concept for injuries of the lower cervical vertebral column

Over a period of two and half years, the Spinal Surgery Working Group of th e Deutsche Gesellschaft fur Unfallchirurgie (German Association for Trauma Surgery) DGU has carried out a prospective study of relevant injuries of th e 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 acciden ts in road traffic and in the pursuit of recreational activities. More than half of the patients had multiple injuries. The share of degenerative conc omitant changes as a cause for relevant injuries increased with age conside rably. In case of a qualified trauma with the suspicion of an injury, the i mmobilisation of the cervical vertebral column has to be retained until the X-ray diagnosis inclusive of a computer tomography has been completed as t his is obligatory for the clarification of suspected findings or for pre-op erative planning, respectively. The diagnostic range is complemented by gui ded function imaging to reveal instabilities, and magnetic resonance imagin g, which has to be carried out in case any X-ray pathology is absent and ne urological 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 prednisolon. A recovery of the neurological abol ition by at least one ASIA level was observed in 10 per cent of the patient s concerned. A conservative therapy with a cervical collar was pursued in 2 4 per cent of the cases with stable injuries. An operative treatment indica tion, which was diagnosed in 76 per cent of the cases, aims at the early re covery of the anatomy with decompression of the spinal cord, reposition, an d stabilisation of segments concerned. The point of the operation was deter mined by the neurological status, the existing dislocation, and the increas ing 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 proc edure with various special implants has proved to be safe and reliable in t he healing result. Dorsal accesses shall remain reserved for definable indi vidual indications and should be prevented in case of injuries of the cervi cal medulla, if possible, to spare the cervical muscles.