The Incidence of Craniosacral Injuries in Comatose Patients

After an automobile injury, significant fall or major sports injury, some patients can have a c-spine injury such as a c-spine fracture. They can also have a closed head trauma which results in coma. Combined craniocervical spinal injury and coma has not been studied by very many researchers. In this research study, the combined effects of having a craniosacral injury and coma have been studied. The comatose patients all had traumatic brain injury.

A total of 1,026 patients with a traumatic brain injury were studied. They were looked at for the presence of any cervical injury, including the type and location of the injury, the occurrence of hypotension in these patients and the presence of dyspnea.

Only 6.9 percent of TBI (Traumatic Brain Injury) patients or 71 patients sustained both a cervical spine injury and a traumatic brain injury. Usually, it was the upper cervical vertebrae that were involved (about 52 percent of all TBI and cervical injury patients) and, of these patients (71 patients), 59 percent had hypotension. (Hypotension is low blood pressure.) About 36 percent or 26 patients had shortness of breath or dyspnea.

The researchers looked at the severity of the two injuries the patients who had dual injuries. There was a difference between those who had a Glasgow coma scale of 3-5 (which is more severe) and those who had a Glasgow coma scale of 9-12 (which is less severe). Eleven percent of people with the lowest Glasgow coma scale had cervical spine injuries when compared to 4 percent of those who had the best Glasgow coma scale.

The combination of cervical spine injury and traumatic brain injury was most associated with motorcycle injuries. More than ten percent of the time, the injury combination occurred with motorcycle injuries.

The researchers concluded that lower Glasgow coma scores in patients put them at risk for cervical spinal injury. What this means is that doctors who are faced with a traumatic brain injury patient who has a low Glasgow coma scale needs to have a high index of suspicion for a cervical spine injury, particularly a high cervical injury. A high cervical injury, if it affects the spinal cord, can affect the patient’s ability to breathe on their own and affects the blood pressure and other vital activities.

The evaluation should go from assessing the patient’s Glasgow coma score while the patient is in a cervical collar. If necessary, the patient needs to be intubated if there is a loss of ability to maintain oxygen levels or if there is hypercapnia (high CO2 levels). Then an x-ray or CT scan of the neck needs to be done to rule out concomitant cervical spine injuries. If the C-spine injury exists, there needs to be two specialists involved: a neurologist or neurosurgeon and an orthopedist who specializes in stabilizing the cervical spine. Sometimes a cervical spine surgery needs to be delayed until the neurologist clears the patient from a brain standpoint. Then a stabilizing cervical spine surgery can be done to make sure no more cervical injury to the spinal cord can occur.