Treatment of Injuries to the Subaxial Cervical Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)
Treatment of Injuries to the Subaxial Cervical Spine: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU)
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DOI：
10.1177/2192568217745062
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发表时间：
2018-09-01
影响因子：
2.4
通讯作者：
Zimmermann, Volker
中科院分区：
文献类型：
--
作者：
Schleicher, Philipp;Kobbe, Philipp;Zimmermann, Volker
研究设计：专家共识。根据目前的文献和德国骨科与创伤学会脊柱分会的知识，建立下颈椎损伤的治疗建议。方法：本建议总结了德国骨科与创伤学会脊柱分会的知识。结果：治疗目标是稳定，无痛颈椎和防止继发性神经损伤，同时保持最大可能的运动和脊柱轮廓。AOSpine分类是下颈椎损伤的推荐分类。建议使用加拿大C型脊柱规则来决定是否需要成像。计算机断层扫描是最受欢迎的方式。传统的X光检查保留用于缺乏“危险损伤机制”的病例。“磁共振成像是推荐在不明原因的神经功能缺损的情况下，在闭合复位和排除椎间盘韧带损伤之前。在高度小关节损伤或存在椎基底动脉症状时，建议进行计算机断层扫描血管造影。A0-、A1-和A2-损伤保守治疗，但必须监测进行性脊柱后凸。A3损伤在大多数情况下进行手术。A4型和B型及C型损伤可通过手术治疗。大多数损伤可以通过前路钢板稳定和椎体间支撑治疗; A4骨折需要椎体置换。在某些情况下，需要额外或单纯的后路内固定。通常，侧块螺钉就足够了。结论：这些建议为下颈椎损伤的治疗提供了一个框架。他们提供有关诊断措施和治疗策略的建议。
Study Design: Expert consensus.Objectives: To establish treatment recommendations for subaxial cervical spine injuries based on current literature and the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma.Methods: This recommendation summarizes the knowledge of the Spine Section of the German Society for Orthopaedics and Trauma.Results: Therapeutic goals are a stable, painless cervical spine and protection against secondary neurologic damage while retaining maximum possible motion and spinal profile. The AOSpine classification for subaxial cervical injuries is recommended. The Canadian C-Spine Rule is recommended to decide on the need for imaging. Computed tomography is the favoured modality. Conventional x-ray is preserved for cases lacking a "dangerous mechanism of injury." Magnetic resonance imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and to exclude disco-ligamentous injuries. Computed tomography angiography is recommended in high-grade facet joint injuries or in the presence of vertebra-basilar symptoms. A0-, A1-and A2-injuries are treated conservatively, but have to be monitored for progressive kyphosis. A3 injuries are operated in the majority of cases. A4-and B-and C-type injuries are treated surgically. Most injuries can be treated with anterior plate stabilization and interbody support; A4 fractures need vertebral body replacement. In certain cases, additive or pure posterior instrumentation is needed. Usually, lateral mass screws suffice. A navigation system is advised for pedicle screws from C3 to C6.Conclusions: These recommendations provide a framework for the treatment of subaxial cervical spine Injuries. They give advice about diagnostic measures and the therapeutic strategy.