The document discusses neck and spine trauma, providing guidelines for patient assessment, physical examination, and classification and management of spinal and spinal cord injuries. It emphasizes approaching every trauma patient using ATLS principles, assuming a spinal injury until proven otherwise. A high index of suspicion of spinal injury is warranted if neurological deficit, multiple injuries, head or facial injury, or high-energy mechanisms are present. Physical examination includes identification of shock types and a full spinal examination and neurological assessment. Management principles involve spinal realignment, stabilization if the injury is unstable, and early decompression of neural elements.

1. NECK AND SPINE
TRAUMA
Sana Rasheed
Akhtar Saeed Medical and Dental College

2. PATIENT ASSESSMENT
Basic points
■ Approach every trauma patient in the same manner usingAdvancedTrauma Life Support (ATLS)
principles.
■ Assume that every trauma patient has a spinal injury until proven otherwise; all assessment,
resuscitation and life-saving procedures must be performed with full spinal immobilization.
■ However, patients must be removed from spinal boards as soon as possible to avoid skin breakdown,
particularly in cases of spinal cord injury and unconsciousness.
■ There should be a high index of suspicion of spinal injury if any of the following are evident:
– neurological deficit;
– multiple injuries;
– head injury;
– facial injury;
– high-energy injury (e.g. fall from a height);
– abdominal bruising from a seatbelt, suggestive of a possible
– lumbar spine injury.

3. PHYSICAL EXAMINATION
■ Identification of shock
– Hypovolemic shock, Neurogenic shock, Spinal shock
■ Spinal examination
– The entire spine must be palpated and the overlying skin inspected. A formal spinal
log roll must be performed to achieve this. Significant swelling, tenderness or
palpable steps or gaps suggest a spinal injury. Note the presence of any wounds that
might suggest penetrating trauma and document the condition of the skin,
particularly over the pressure areas.
■ Neurological examination

4. CLASSIFICATION AND MANAGEMENT
OF
SPINAL AND SPINAL CORD INJURIESBasic management principles
■ Spinal realignment
■ Stabilisation
– If a spinal fracture or dislocation is unstable (moves abnormally when stressed)
there is a risk of new or further neurological injury as well as painful post-traumatic
deformity. Many spinal injuries can be managed non-operatively with external
support but, when possible, internal fixation should be used.The only absolute
indication for surgery in spinal trauma is deteriorating neurological function. All
other indications are relative.
■ Early stabilisation has the advantage that it allows early mobilization of the patient.
■ Decompression of the neural elements

5. References
■ Bailey and Love's Short Practice of Surgery