Diagnostics and indications for surgical treatment

Following the initial assessment of the patient, detailed diagnostic radiography defines the bony damage and compression of the spinal cord. First, lateral, anteroposterior, odontoid, and possibly oblique cervical spine radiographs are obtained. If there is no evidence of injury, flexion and/or extension views may be considered. If any of these radiographs suggest cervical spine abnormalities, specific radiological procedures such as cervical myelography, high-resolution CT scan, or magnetic resonance imaging will identify fractures, dislocation of bony fragments, and spinal cord contusion. In patients with a dislocated cervical fracture, decompression and anatomical bony realignment may be achieved with traction forces applied manually or with Halo or Gardner-Wells systems under radiological control. If the anatomical bony alignment procedures and traction forces fail to decompress the cord, surgical intervention to remove the lesion is required. The timing of surgical intervention remains controversial. While urgent surgical decompression or internal stabilization should be performed in all patients with deteriorating neurological status, some centers tend to defer surgical treatment in patients with spinal cord injury but stable neurological deficit.

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