Missed cervical dissociation--recognizing and avoiding potential disaster.

Abstract

Complete cervical disruptions are high-energy injuries often associated with polytrauma and spinal cord injury. Because these injuries disrupt all anterior and posterior stabilizers, they result in a highly unstable spine, and the injuries are usually apparent on screening radiographs. Patients with these injuries must be identified and protected during the multiple diagnostic and surgical procedures they may require during their initial evaluation and treatment. Emergency procedures must be carefully prioritized relative to other life-threatening injuries; formal evaluation of the cervical spine may be carried out before, after, or in stages around other urgently indicated procedures. Until the cervical spine is cleared, careful observation of precautions can avoid disasterous complications in even the most unstable situation. A case of complete cervical disruption in a neurologically intact, hemodynamically unstable patient is presented for discussion. For polytraumatized patients with cervical dissociation, combined anterior and posterior stabilization is the treatment of choice.