Universität zu Köln

Schleicher, Philipp, Scholz, Matti, Kandziora, Frank, Badke, Andreas, Brakopp, Florian Hans, Ekkerlein, Helmut Klaus Friedrich, Gercek, Erol ORCID: 0000-0002-5996-2947, Hartensuer, Rene ORCID: 0000-0002-6175-2754, Hartung, Philipp, Jarvers, Jan-Sven Gilbert, Kobbe, Philipp, Matschke, Stefan, Morrison, Robert, Mueller, Christian W., Pishnamaz, Miguel, Reinhold, Maximilian, Schnake, Klaus John, Schmeiser, Gregor, Stein, Gregor, Ullrich, Bernhard, Weiss, Thomas and Zimmermann, Volker (2017). Subaxial Cervical Spine Injuries: Treatment Recommendations of the German Orthopedic and Trauma Society. Z. Orthop. Unfallchir., 155 (5). S. 556 - 567. NEW YORK: THIEME MEDICAL PUBL INC. ISSN 1864-6743

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Abstract

In a consensus process during four sessions in 2016, the working group lower cervical spine of the German Society for Orthopedic and Trauma Surgery (DGOU), formulated Therapeutic Recommendations for the Lower Cervical Spine, taking into consideration the current literature. Therapeutic goals are a permanently stable, painless cervical spine and the protection against secondary neurologic damage while retaining the greatest possible amount of motion and spinal profile. Due to its ease of use and its proven good reliability, the AOSpine classification for subaxial cervical injuries should be used. The Canadian C-Spine Rule is recommended as a clinical decision rule whether to perform imaging or not. If a structural or unstable injury is suspected by patient history or clinical findings, a spiral CT scan of the cervical spine is the favoured diagnosticmodality. Conventional X-ray is reserved for patients in whom there is no dangerous mechanism of injury. MR imaging is recommended in case of unexplained neurologic deficit, prior to closed reduction and open posterior surgery and to exclude disco-ligamentous injuries. Urgency of MR imaging depends on the specific findings. CT angiography is recommended in higher-grade facet joint injuries or in the presence of vertebra-basilar symptoms. Flexion-extension imaging is recommended only as a physician-guided dynamic fluoroscopy, when an unstable lesion is still suspected. The therapeutic strategy is mainly dependent on morphologic criteria, which are described using the AOSpine classification. A0-injuries are treated conservatively. A1- and A2-injuries are treated conservatively in the majority of cases, and in single cases a gross kyphotic deformity might indicate surgical stabilisation. A3-injuries do indicate a surgical therapy in the majority of cases, but certain cases might be treated conservatively. A4-fractures as well as B- and C-type injuries are to be treated surgically. Most injuries can be treated by anterior plate stabilisation with interbody support; when a complete burst fracture is present, corpectomy and vertebral body replacement is necessary. In certain cases, an additive posterior or pure posterior instrumentation might be possible or even mandatory. In most of these cases, lateral mass screws are sufficient; when pedicle screws are applied in C3 to C6, a 3D-navigation system is recommended. Injuries in an ankylosing spine (M3-modifier) should be treated preferably from posterior with long-segment instrumentation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Schleicher, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Scholz, Matti UNSPECIFIED UNSPECIFIED UNSPECIFIED Kandziora, Frank UNSPECIFIED UNSPECIFIED UNSPECIFIED Badke, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Brakopp, Florian Hans UNSPECIFIED UNSPECIFIED UNSPECIFIED Ekkerlein, Helmut Klaus Friedrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Gercek, Erol UNSPECIFIED orcid.org/0000-0002-5996-2947 UNSPECIFIED Hartensuer, Rene UNSPECIFIED orcid.org/0000-0002-6175-2754 UNSPECIFIED Hartung, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Jarvers, Jan-Sven Gilbert UNSPECIFIED UNSPECIFIED UNSPECIFIED Kobbe, Philipp UNSPECIFIED UNSPECIFIED UNSPECIFIED Matschke, Stefan UNSPECIFIED UNSPECIFIED UNSPECIFIED Morrison, Robert UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Christian W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pishnamaz, Miguel UNSPECIFIED UNSPECIFIED UNSPECIFIED Reinhold, Maximilian UNSPECIFIED UNSPECIFIED UNSPECIFIED Schnake, Klaus John UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmeiser, Gregor UNSPECIFIED UNSPECIFIED UNSPECIFIED Stein, Gregor UNSPECIFIED UNSPECIFIED UNSPECIFIED Ullrich, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Weiss, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Zimmermann, Volker UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-216100
DOI:	10.1055/s-0043-110855
Journal or Publication Title:	Z. Orthop. Unfallchir.
Volume:	155
Number:	5
Page Range:	S. 556 - 567
Date:	2017
Publisher:	THIEME MEDICAL PUBL INC
Place of Publication:	NEW YORK
ISSN:	1864-6743
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COMPUTED-TOMOGRAPHY; PEDICLE SCREWS; LOW-RISK; RULE; THORACOLUMBAR; RADIOGRAPHY; PLACEMENT; CRITERIA; CT Multiple languages Orthopedics Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/21610