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C-spine injuries

Janei Brockhausen Harling jdbee01 at gmail.com
Tue Oct 11 15:15:03 BST 2005

HI Jim,
 I just thought I'd intersect some information here. I worked with a doc who
was sure many of the migraine headaches we see(true, miserable ones) were
from laxity of the ligaments around C2. He did anesthesia and there were
many cases where they found just that. Not fx'd C2's, but enough laxity that
when these were stabilized, the h/a's went away, never to return. Most of
the Migraine pts had hx's of injury somewhere in their past. Not all MVA's,
but some type of injury.
 janei PA-C

 On 10/10/05, Jim Ouellet <hlmtxprt at yahoo.com> wrote:
> I don't know if this will advance the discussion of
> clearing C-spine injuries, but I figure it'll do more
> than adding to the recent political commentary. I've
> worked on motorcycle accidents for about 30 years now
> and published a couple papers on neck injuries in
> fatal crashes (citations below). All of the
> published cases (about 380 so far) have had a
> detailed, layer-by-layer dissection of the anterior &
> posterior neck, which included removal of the cervical
> cord (often en bloc with the brain) for neuropath
> analysis.
> What really stood out was not the fractures or
> dislocations – which were relatively uncommon – but
> the soft tissue injuries, particularly hemorrhage in
> the carotid sheath, hemorrhage around the vertebral
> arteries at C6 and C1 and subluxation of the
> atlanto-occipital and atlanto-axial joints, which
> typically showed up as stretching or laxity of the
> joints -- but only when the head was rotated or a
> tension load placed on the neck. If I recall
> correctly, 5-10 mm of excess motion in a joint was
> pretty common.
> Overall, ~7% of fatals had C1-C2 fracture only, ~10%
> had dislocation-only and 2% had fracture-dislocation
> at C1-C2. But about 55% showed signs of subluxation.
> About one-third of the total had some type of injury
> to the cervical cord, usually minor contusions around
> C1-C2.
> I know these were all fatalities, but I've always
> suspected that there are more subluxation injuries
> among severely injured riders than I've seen diagnosed
> in non-fatal cases, and I've often suspected the
> reason is partly because of reliance on X-rays that
> don't pick up the evidence. To quote one my favorite
> people, the eloquent architect of Iraq intervention,
> Donald Rumsfeld, "Absence of evidence doesn't mean
> evidence of absence."
> ~~~~~~~~~
> Hurt, HH, Jr., Ouellet, JV & Rehman, I, Epidemiology
> of head and neck injuries in motorcycle fatalities,
> in Mechanisms of Head and Spine Trauma, (A Sances, DJ
> Thomas, CL Ewing, SJ Larson & F Unterharndscheidt,
> Eds.), Aloray Publishers, Deer Park, NY, 1986.
> Kasantikul V, Ouellet JV & Smith TA, Head and neck
> injuries in fatal motorcycle collisions as determined
> by detailed autopsy, Traffic Injury Prevention, 4
> (3), 255-262, 2003.
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