Management of Cervical Spine Erosion and Hypothermia
For patients with cervical spine erosion and hypothermia, immediate rewarming to achieve normothermia should be prioritized, while cervical spine stabilization should be maintained manually rather than with cervical collars until definitive treatment can be provided. 1
Hypothermia Management
- Immediately apply measures to reduce heat loss and actively warm the hypothermic patient to achieve and maintain normothermia 1
- Remove wet clothing, cover the patient to prevent additional heat loss, increase ambient temperature, and use forced air warming 1
- For severe hypothermia, consider warm fluid therapy and, in extreme cases, extracorporeal rewarming devices 1
- Avoid prolonged hypothermia as it is associated with acidosis, hypotension, coagulopathy, increased blood loss, and higher mortality in trauma patients 1
Physiological Effects of Hypothermia
- Each 1°C drop in temperature is associated with approximately 10% decrease in coagulation factor function 1
- Body temperatures below 34°C significantly compromise blood coagulation 1
- Hypothermia causes altered platelet function, impaired coagulation factor function, enzyme inhibition, and fibrinolysis 1
Cervical Spine Management
- For suspected cervical spine injury, maintain spinal motion restriction by manually stabilizing the head to minimize movement of the head, neck, and spine 1
- Manual stabilization is preferred over cervical collars for first aid providers 1
- Avoid using cervical collars by first aid providers as they have not shown clear benefit and may cause complications 1
Rationale for Manual Stabilization Over Collars
- The ability to properly apply cervical collars is not typically taught in first aid courses 1
- Cervical collars are no longer used routinely for trauma and are reserved for injuries with high risk of cervical spinal injury 1
- First aid providers may have difficulty discriminating between high and low risk for spine injury 1
Special Considerations for Vertebral Body Erosion
- If vertebral body erosion is identified, a thorough evaluation for possible aortic aneurysm should be conducted 1
- Vertebral body erosion can be rarely associated with aortic wall disorders such as chronic contained rupture of aortic aneurysm (CCR-AA) 1
- Symptoms may include back pain and/or neurologic lower limb motor or sensory deficits 1
- Advanced imaging (CT, MRI) is essential for proper diagnosis and treatment planning 1
Treatment Approach
- For vertebral erosions associated with aortic aneurysm, a combined vascular and neurosurgical approach may be necessary 1
- Loss of vertebral body substance up to 30% can often be well tolerated and may naturally mend after aneurysm repair, but each case requires evaluation by a spine specialist 1
- Vertebral fusion may be needed to restore spinal stability 1
Clinical Pitfalls and Caveats
- Diagnostic uncertainty is common with cervical spine erosion, especially when associated with aortic pathology, due to absence of systemic signs of rupture 1
- Hypothermia may mask symptoms and signs of underlying injuries or conditions 1
- Side effects of rewarming may include hypotension, hypovolemia, electrolyte disorders, insulin resistance, and increased risk of infection 1
- Avoid applying ice directly to any associated injuries as it can produce tissue ischemia 1
- For any patient with cervical spine injury and hypothermia, prompt transport to definitive care is essential 1
Evidence Limitations
- There is limited high-quality evidence for the management of specific isolated cervical fracture subtypes 1
- Few randomized clinical trials have been conducted for cervical spine injuries, and those that exist often don't account for the complexity and variability of injury patterns 1
- While some small studies have explored therapeutic hypothermia for spinal cord injuries, this approach remains investigational and is not recommended as standard treatment for cervical spine erosion with hypothermia 1, 2, 3, 4, 5