Approach To Management Of Cervical Spine Injuries: A Prospective Observational Study

Abstract

Background: Cervical spine injuries are serious traumatic events that can lead to neurological deficits and long-term disability if not managed promptly. Due to the cervical spine’s dependence on ligamentous support, early diagnosis and appropriate stabilization are essential to preserve neurological function and spinal alignment.

Aims and Objectives: To evaluate the clinical presentation, radiological findings, injury classification, treatment strategies, and outcomes in patients with cervical spine trauma, and compare the effectiveness of surgical versus conservative management.

Methods: This prospective observational study was conducted over 18 months in a tertiary trauma centre. Patients with confirmed cervical spine injuries on CT/MRI were assessed using the ASIA Impairment Scale and classified using AO Spine and SLIC systems. Based on stability and neurological status, patients were treated conservatively (cervical orthosis, traction) or surgically (anterior/posterior/circumferential fixation). Outcomes were measured using neurological recovery and radiological healing.

Results: A total of 52 patients were enrolled, with a mean age of 39.4 years and a male-to-female ratio of 3.3:1. The most frequently injured levels were C5–C6 (36.5%) and C6–C7 (30.8%). Road traffic accidents were the predominant cause (59.6%), followed by falls (25%) and sports-related injuries (7.7%). Neurological deficits were observed in 63.4% of cases at presentation. Conservative treatment was administered to 29 patients (55.8%) with stable fractures, all of whom showed preserved or stable neurological status and good radiological outcomes. Surgical management was required in 23 patients (44.2%) based on instability or neurological involvement. Among these, the anterior approach was used in 56.5%, posterior in 34.8%, and combined in 8.7% of cases. Early surgery (<24 hours) was performed in 18 patients, yielding ASIA grade improvement in 66.7% of cases, compared to 40.0% in those operated after 24 hours. Minor complications included superficial wound infection (3.8%), transient C5 palsy (1.9%), and dysphagia after anterior surgery (3.8%). No cases of implant failure or reoperation were reported.

Conclusion: Cervical spine trauma requires timely, classification-based management. Early surgery improves outcomes in select patients, while stable injuries respond well to conservative care. Individualized treatment decisions remain central to optimizing recovery.