Recommended Cervical Spine Management
This article aims to explain the recommended manner to carry out lower cervical spine management.
How is instability in the lower cervical spine to be treated? It has to be said that, even when a particular spine has indeed been determined as clinically ‘unstable’, current literature is rather inconclusive as to whether surgical or nonsurgical treatments are better. Patients should always be taught how to maintain good posture. It is very important that they understand that keeping a good posture is vital to their successful recovery and to help keep their spine stabilised after treatment through such practice or the use of braces, as it is not uncommon for people who have had instability at some point to redevelop this instability.
Intensity of Cervical Spine Injury or Trauma
Patients with cervical spine fractures, cervical spine disorders, or cervical spine disruptions, should be kept under bed rest, in skeletal traction if severe, for between one and seven days. If there is involvement of the spinal cord, be there fractures or fracture dislocations, this is considered a major injury. Patients with only minor decompression fracture, or none at all, may be treated simply with head-halter traction. If there is only minor injury present, such as a pulled muscle or a sprain, then traction is not necessary – instead the patient may be treated for the symptoms alone, and observed. Later, they should be examined radiographically. These patients should be taught methods to maintain a correct posture such as the Alexander Technique posture which is a simple and effective way of keeping a healthy, stabilised spine.
During the first week of traction, patients should be given thorough clinical evaluation and whatever supportive care is deemed necessary. After stabilising (physiologically), the patient should be evaluated for decompression. Then it is possible to attempt closed reduction with traction. If needed in order to rule out clinical instability, the various manoeuvres and tests for this ought to be performed. In cases where the decompression itself renders the spine clinically unstable, reconstruction and fusion may be needed and may be carried out.
When Diagnosed Clinically Stable
Once diagnosed clinically stable, patients should be comfortable within three to six weeks. Their problems should be healing by this time. A cervical collar may be necessary or desirable for support and also may encourage effective control of movement. The device should be sufficient to protect the patient from neurologic damage and allow injured structures to heal up. However, clinical instability may (re)develop.
Cervical Spine Management if Remaining Clinically Unstable
There are three basic options for cervical spine management if a patient remains clinically unstable. Firstly, a successful fusion is the preferred option and strongest reconstruction for the unstable segment of the cervical spine. However that of course carries all the risks that come with spinal surgery. This option should be followed by 15 weeks of orthosis. The second option would be use of the halo traction apparatus for 11 weeks, which has been used with or without fusion in the treatment of spine trauma. The halo apparatus does indeed provide the best immobilisation to facilitate healing of ligaments and this process should be again followed by orthosis, for just four weeks. The third option is skeletal traction for another seven weeks followed by an orthosis of eight.
As mentioned, it should be made clear to all stabilised patients that the maintenance of good posture is key to maintaining their recovery. Patients should also be recommended posture correctors to help keep them stable on their recovery.
All of these methods of cervical spine management should include careful clinical follow up evaluations.