Yeah, so our next speaker is Dr. Syed from Algeria, subaxial cervical trauma in adults. Thank you. Good morning. Dear colleague, I would like to express my thanks to the president, Mr. Willard Carr of WNS, for inviting us as a member and lecturer of CANS, Continental Association of Neurosurgical Society. Thank you. My talk is my talk about the subaxial cervical trauma is a veritable challenge in the emergency room. And also, the frequency is high. And so, for introduction, the subaxial cervical spine accounts the vast majority of cervical injury, making up to three of all cervical fractures. So, these traumas are common with the prevalence of disc and ligament damage and numerous physiopathologic mechanisms. Systemic and simple radiological exam allows the diagnostics in 90% of cases. What is the subject of this lesion? In the two columns, anterior columns, with body anterior ligamentus, and also posterior column with spinal canal, articular pillar, neural arch, and posterior ligaments. And also, as said, Professor Fuentes, don't forget the one we operated the artery vertebra. The severity of this lesion attests of the wide variety and the diversity of pathological mechanisms from a simple, single, and minor ligamentous strain to the complete fracture dislocation with bone and ligament failure resulting in spinal and spinal cord injury. The severity in the radiography is shown by the ontolestesis greater than 3.5 millimeters above and angulation of the vertebral plate of more than 10 degrees, loss of parallelism of faceta joints, and discovery of more than 50% of the superior articular process of the vertebra below the lesion. And also, the abnormal interspinal spice and cervical nerve root damage and cervical spinal cord damage. The instability is very well-definited by White and Panjabi in 1987. The mechanism, the classical classification, hyperflexion, axial compression, and also hyperextension impaction. The treatment must be individualized in the basis of the specific characteristics of each particular injury. For in the emergency, the clinical exam will show that 84% of patients with clinical exam and fracture have middle neck pain. And also, 20% of patients with clinical significant cervical spine fracture with negative plane seems to have a fracture on CT scan. So it's very important to the complete neurological exam in emergency. So, the radiography, we have the single, simple radiography lateral spine to include C7 to T1. We see the bone anatomy, the soft tissue detail, include C7 and T1. And also, the negative study does not rule out injury. If pain filled, immobilization and re-evaluation after one to two weeks. The timing for the flexion extension X-rays is so controversial. And in cooperative patient with pain and negative previous radiography, you must do it. The classification, the classical classification, we use the last classification, subaxial cervical spine injury classification of Vaccaro in 2007. This is the classification. We tend to account of morphology of the trauma. We tend to account of disco-ligamentous complex. And also, we take account of neurological status. So, this score of subaxial help to determine information about trauma and its severity to treatment consideration, to treatment considering the prognosis by using mechanism, disco-ligamentous complex and also neurological status. This score, when the score is less than four, the treatment is not surgical. Medical treatment is used. When it is discussed, when the score is at four, and also when more than five, surgical is recommended. We have our review with our study in two years, 2016-2017, with 20 patients. We have the young people with the maximum young people and also the men in 85 person. The symptom, the clinical deficit, is more than the neck pain and also a deficit of motor or sensitive motor, like tetraparesia or tetraplegia. And we have the motor deficiencies of tetraparesia and tetraplegia in 30 cases, our last cases. Other associated lesions, we have trauma in the brain, trauma brain injury, and also the lesion of the rashes, dorsal or lumbar, associated to the lesion of cervical spine. The imaging, we have used in all cases the radiography and the CT scan in 95 and MRI in five person. The treatment, it was no surgical in 10% and the treatment was surgical in other cases. Evolution and complication, we have 50 person died, so three patients, and we have one cases with infection with evaluated correctly by antibiotherapy. This is illustrative cases, a young of 21 years presented a cervical trauma after sea dive. So the clinical exam, neck pain and stiffness with limitation of neck movement. Neurological examination is normal and does not present any motor or sensory deficit. The radiography, you see there a severe subaxial trauma of cervical spine with mechanism flexion distraction, disruption of anterior and posterior complex ligamentus, lesion of the disc, and abnormal vertebral displacement caused compression and damage to neural structure without clinical exam symptom. This is the CT scan, you see there the obliquity and congulation at the level of injury at C4, C5. We have the displacement of more than three millimeter and interspinous distance enlargement. This is the CT scan, we see the left lateral view and the right lateral view, you see the dislocation of the C4, C5. This is the same case with CT scan and also the CT scan with disc herniation. This is the same case and also... So this discussion, severe subaxial trauma with dislocation C4, C5. It is unstable lesion with slight classification squalatinine, anterior compression with disc and antelastesis with displacement. The progressive cervical traction is used and also the surgery was done. This reduction will be with gradual increase of height and we have after reduction operated the patient. So the question, do you use the anterior approach or the posterior or the both? The compression is mostly anterior in our case. Anterior procedure is to be performed first to relieve the cord compression after obtaining alignment by cervical traction. The discussion, should we complete this procedure by posterior fixation? This is the pair operative view with the anterior abort. We're using the Caspar as material and we have a reduction. And also we have used a plate with graft, sacral graft between C4 and C5. Another case is the classical frequent cervical trauma. It's the unilateral dislocation which is reduced by traction and also anterior abort was performed and the treatment was very well. So third cases, this is a young 26-year-old with a motor vehicle accident with multiple lesions. Bilateral facet dislocation with fractured separation of the articular and fracture of lamina and also you see there, you have performance by posterior approach and with a reduction and also in the same time operative, you have used a complete for the good stability and anterior approach. This is some view of the management. So in conclusion, subaxial cervical spine is a comment by serious spinal injury. It is frequently associated with spinal cord injury and there is no consensus regarding the approach for stabilization of spine, either anterior or posterior or both. Successful treatment based on knowledge of anatomy mechanism of injury and compromise of bone and or soft tissue by a restored alinium. Stabilization of spine with decompression and restore function. Thank you for your attention. Thank you.

subaxial cervical trauma

adults

emergency room

neurological examination

radiography