Unrecognised fractures and dislocations of the cervical spine.

Failure to diagnose a fracture of the spine may lead to spinal cord damage due to incorrect handling of the patient. The three most common causes of failure to radiologically diagnose a fracture of the cervical spine after injury are: (1)inadequate demonstration of the entire cervical spine on the lateral view; (2) Failure to X-ray the cervical spine after head injury; (3) Incorrect interpretation of the radiological appearances. The relevant radiological features are discussed.

The value of erect radiographs in cervical spine injury.

Certain flexion injuries of the cervical spine may be evident radiologically only if the patient is radiographed in the erect position. Because radiographs of an injured patient are usually obtained in the supine position, the abovementioned injuries may be overlooked. The importance of radiographs taken with the patient in the erect position is illustrated by a case report.

The value of retropharyngeal swelling in the diagnosis of fractures of the Atlas.

The Jefferson or bursting fracture of the atlas is frequently overlooked. This is because neurological deficit is usually absent and physical findings are nonspecific. In addition, diagnosis of this fracture cannot be made from the lateral radiograph of the cervical spine.

The diagnostic value of the anteroposterior radiograph for thoracolumbar spinal injuries.

Identification of fractures of the posterior elements of thoracolumbar vertebrae is important because these fractures render the spine unstable. Technically it is difficult to demonstrate the posterior elements on a supine lateral radiograph in patients with multiple injuries. Careful inspection of the posterior vertebral structures on the anteroposterior view will reveal valuable information.

Mobility studies of the cervical spine - helpful but hazardous.

Radiographic 'mobility studies' of the cervical spine are frequently requested to exclude ligamentous damage and instability after injury. Such procedures are hazardous and are often unsatisfactory, as movement of the neck is limited by pain and muscular spasm. Certain precautions are suggested to minimize the risk of inducing spinal cord injury.

Diversity of radiological features in hyperextension injury of the cervical spine.

Hyperextension injuries of the cervical spine, previously considered rare, are now being diagnosed more frequently. The radiological features of these injuries are subtle, and their significance as an indication of hyperextension trauma is often overlooked. Six different hyperextension injuries are described, illustrating the varying radiological appearances.

Dislocation, subluxation or listhesis?

The lack of a generally accepted set of terms to describe traumatic vertebral displacements as shown by different interpretations of the terms 'subluxation' and 'dislocation' is discussed. The need for clear and precise terminology for clinical and research purposes is stressed. Causes for confusion in terminology are briefly outlined.

Cervical spine fusion and the effects of injury.

Congenital or acquired cervical vertebral fusion is sometimes an incidental radiological finding. Such fusions decrease the normal range of spinal movement and predispose to trauma. An analysis of 200 patients with acute cervical spinal cord trauma has been made with reference to pre-existing vertebral fusion and the circumstances of injury.

An evaluation of discrepancy in capacity and contour of the neurogenic bladder as shown on cystography and pyelography.

A significant difference in the filling of the bladder with contrast medium on intravenous pyelography as compared to cystography has been noted in patients with spinal cord injury. Bladder capacity and contour of the bladder wall have been assessed in 50 patients with impaired bladder innervation consequent upon spinal cord injury. In 32% of the patients the bladder capacity was significantly greater when measured on pyelography than that found in cystography.

Anterior cervical subluxation: an unstable position.

The radiologic signs of cervical anterior subluxation are subtle. Even when recognized, the injury may not be considered significant. However, anterior subluxation is the most unstable cervical spinal injury.

Displacement of the spinolaminar line--a sign of value in fractures of the upper cervical spine.

The spinolaminar line is an important anatomical landmark easily visualized on the lateral radiograph of the cervical spine. Any displacement in this line may be an indication of subtle traumatic vertebral damage. This is particularly relevant to the upper cervical spine in which the complex anatomy and frequent absence of associated neurological deficit make diagnosis difficult.

Hypertension following denervation of aortic baroreceptors in unanesthetized dogs.

After cervical aortic nerve section, mean arterial pressure in the unanesthetized dog increased by an average of 7.4 mm Hg. Following a more extensive denervation of aortic arch receptors by section of intrathoracic vagal branches, arterial pressure increased by 16.

Influence of cardiac fiber orientation on wavefront voltage, conduction velocity, and tissue resistivity in the dog.

When the canine epicardium is stimulated, the spread of epicardial excitation is 2.4 times faster parallel to the long axes of the cardiac fibers than perpendicular to them. Likewise, gross tissue resistivity is lower parallel to fibers by a factor of 3.

The value of the anteroposterior radiograph in 'hidden' fractures and dislocations of the lower cervical spine. A case report.

Fractures and dislocations of the cervical spine may be overlooked if the lower cervical vertebrae are not adequately demonstrated on the supine lateral radiograph. Failure to diagnose cervical spinal injury radiologically may have tragic consequences should delayed spinal cord damage ensue. A case report illustrating this is presented.

Are spinal cord injury patients more prone to contrast reactions?

A previous investigation has indicated that spinal cord injury patients are more prone to develop reactions to intravenous contrast media. An investigation into the incidence of contrast reaction in 100 spinal cord injury patients undergoing intravenous pylography together with the incidence in a control group of 100 non-paraplegic patients, has been made. This has shown that spinal cord injury patients do not have a higher incidence of reaction.

Localisation of upper oesophageal foreign bodies in a recumbent tetraplegic patient.

Report of oesophageal obstruction in a tetraplegic patient following swallowing of a chicken bone. Removal following x-ray localisation.

The high rugby tackle--an avoidable cause of cervical spinal injury?

The type and circumstances of injury to 14 rugby players with cervical spinal cord damage sustained during a tackle have been analysed. Two specific mechanisms of injury were evident. Four players were injured when their heads collided with fixed objects while they were attempting to tackle an opponent.

Ligamentous injury of the cervical spine--two radiological signs.

The integrity of the posterior ligamentous complex is important for the stability of the cervical spine. Severe ligamentous injury may occur without radiological evidence of vertebral fracture or dislocation. If overlooked, ligamentous damage may result in vertebral instability with subsequent dislocation and spinal cord injury.