Rugby injuries to the spinal cord.
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Athletic Injuries↗
Biomedical subjects
A T Scher
Publications and source records attributed to A T Scher.
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. These are supervision of the examination by a doctor, prior scrutiny of the neutral lateral radiograph, and permitting voluntary active movement of the neck only within the limits imposed by the patient's condition.
Clinical Competence↗
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.
Aged↗
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. Terminology separately describing displacement of vertebral bodies and apophyseal joints is suggested.
Humans↗
Rugby injuries to the cervical spinal.
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Athletic Injuries↗
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. The analysis showed the patients to be particularly predisposed to hyperextension injury and the risk of spinal cord damage from minor trauma. Precautions which should be taken by these patients to avoid spinal injury are suggested.
Female↗
Rugby injuries to the cervical spinal cord.
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Age Factors↗
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. Two case histories are presented which emphasize the importance of evaluation of the spinolaminar line on the lateral radiograph after trauma to the head and neck.
Adult↗
Dislocation of the cervical spine--a rare manifestation of hyperextension injury. A report of 2 cases.
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Adult↗
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. Since no difficulty is encountered in demonstrating the lower cervical vertebrae on the anteroposterior view with the patient supine, careful attention to the position and appearances of the spinous processes on this radiograph may enable diagnosis of fractures and/or dislocations to be made. Three radiological signs of value are discussed.
Cervical Vertebrae↗
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. The aetiology of contrast reaction is briefly discussed with particular reference to the paraplegic patient.
Contrast Media↗
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. The causes for this discrepancy in bladder filling on the two examinations are discussed. The possibility of erroneous assessment of the capacity and contour of the neurogenic bladder on cystography is pointed out.
Female↗
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. The two case histories illustrate instability of the cervical spine in this type of injury. The radiologically diagnostic features on the lateral radiograph are described and the recognition of instability on mobility studies is discussed.
Adult↗
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. Ten players were injured while being tackled and 5 of them were tackled around the neck. The risk of trauma to the cervical spine caused by the force applied to the neck in a high tackle is discussed. The susceptibility of the ligaments of the cervical spine to the rotational force exerted during a high tackle is stressed. An amendment to the rules of rugby, which would reduce cervical trauma, is suggested.
Athletic Injuries↗
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. Two radiological signs, acute kyphotic angulation and divergence of the spinous processes, which are indirect evidence of ligamentous damage, are described.
Cervical Vertebrae↗
Double fractures of the spine--an indication for routine radiographic examination of the entire spine after injury.
Routine radiographic examination of the entire spine in 103 patients with traumatic spinal cord injuries has demonstrated double fractures of the spine in 5 patients. The incidence, clinical significance and mechanism of injury are discussed. The danger of overlooking the presence of a second spinal fracture in the paralysed patient and thus putting the patient at risk of increased spinal cored injury is stressed. A simple system of radiographic examination is described and routine radiographic examination of the entire spine in all patients who have sustained spinal cord injury is advocated.
Accidents, Traffic↗
Autonomic hyperreflexia. A serious complication of radiological procedures in patients with cervical or upper thoracic spinal cord lesions.
Autonomic hyperreflexia is a reflex response to visceral distension which occurs only in patients with spinal cord lesions above T6. The marked hypertension, which is an integral part of this reflex, may lead to severe morbidity, or even death. The mechanism whereby interruption of the sympathetic outflow from the spinal cord results in autonomic hyperreflexia is described, as well as the clinical signs and symptoms associated with this condition. The value of autonomic hyperreflexia as a clinical indicator of complications in patients with spinal cord lesions is stressed. The diagnosis and treatment of autonomic hyperreflexia which has occurred as a complication of radiological procedures are discussed.
Humans↗