A few days ago, Lao Liu took the shuttle bus to work as usual, who knew that the flying accident. He saw a truck coming from the front. The driver quickly rotated the steering wheel and slammed on the brakes to avoid the frontal impact of the big truck. But in this moment, the passenger Lao Liu swayed back and forth with the car, shaking his head sharply, suddenly felt the sky and earth, limbs limp and weak, fell in his seat. He was soon taken to the orthopedic department of Beijing Ditan Hospital for treatment. After a thorough physical examination, cervical spine CT and MRI, he was diagnosed with cervical spinal cord injury with tetraplegia. It turned out that Lao Liu is a high-risk cervical spine, 3 years ago he felt cervical discomfort, this car accident is to add to his pain, all due to the emergency brake caused by the cervical spine “whipping injury”. He was puzzled by this: it’s incredible, a good person will be paralyzed by a sharp brake, it’s terrible! Because the elderly are prone to falls and traffic injuries, cervical whiplash-like injuries are more common in the middle-aged and elderly. In patients with whip-like injury involving the cervical medulla, mild external force can cause the middle-aged and elderly patients to have more severe spinal cord injury symptoms or tetraplegia, which may be related to the increase in cervical spine degeneration with age, causing cervical spinal canal narrowing and reduced compensatory space. Therefore, in our daily life, we should pay enough attention to protect our cervical spine from paralysis. What is a high-risk cervical spine? In terms of age, it is possible for anyone over 40 years old, but it is less likely to occur in those who originally had a relatively wide cervical spinal canal. Since there are pathological factors in the cervical spine that can easily lead to damage to the spinal cord and nerve roots, such as congenital anomalies, developmental anomalies, degenerative changes, etc., symptoms of spinal cord and nerve root damage can occur with a mild accidental injury to the cervical spine in daily life, and we call this type of cervical spine a high-risk cervical spine. The essence of high-risk cervical spine is that the safety reserve gap of the cervical spinal canal is significantly reduced, so that the medulla oblongata and spinal cord are in a high-risk state. In the normal spinal canal, a certain gap exists around the spinal cord, and the spinal cord has a certain range of drift in the cervical spinal canal. After middle age, the cervical spinal cord is compressed due to degenerative disc hypertrophy, vertebral body and small joint osteophytes, and ligamentous hypertrophy, all of which occupy the spinal canal that was not originally wide enough. The cervical spinal cord itself has a good compensatory capacity. Although the presence of the original cervical spine disease destabilizes the structure of the cervical spine, the compensatory mechanisms make the cervical spinal cord more compliant and resistant to injury in this segment of the spinal canal, and it is more compatible with the spinal canal, so it can adapt when it is slowly squeezed, so the symptoms of spinal cord nerve compression may not be obvious or light. However, at this time, the cervical spinal cord is like a stretched rope, and the cerebrospinal fluid protected around it is not circulating well. The cervical spinal cord has no room for expansion and contraction within the spinal canal, and once there is trauma, serious injury can occur even if it is very mild. If you usually feel discomfort in the neck and shoulders, or numbness in the upper limbs, or unstable walking, you may want to go to the hospital for a checkup. The easiest way is to take an X-ray of the cervical spine. Of course, a CT or magnetic resonance imaging (MRI) examination is more intuitive and can directly observe the spinal cord compression. For patients with symptoms of cervical spondylosis, it is worthwhile to have an MRI examination, which is more conducive to diagnosis and treatment. What is a whiplash injury? A whip-like injury is defined as an injury to bone or cartilage tissue caused by a rear or lateral impact that increases or decreases the speed of the neck, and refers specifically to an injury caused by sudden hyperextension and hyperflexion of the head and neck caused by a rear-end collision with a motor vehicle. The cervical spine of middle-aged and elderly people often have narrowing of the intervertebral space, degenerative disc disease, vertebral instability, and developmental stenosis of the cervical spinal canal, and the spinal cord has less space for movement in the spinal canal or disappears, which is the pathological basis for aggravating the symptoms of whiplash-like injury in middle-aged and elderly people. In congenital or acquired stenosis of the cervical spinal canal, the cushion space for the spinal cord becomes significantly smaller, the diameter of the cervical spinal cord and the dural sac becomes larger during hyperextension, the ruptured protruding intervertebral disc and the posterior folded invagination of the ligamentum flavum and the bone superfluous at the posterior edge of the vertebral body make the spinal canal gap narrower, the spinal cord has no or little room to yield in the spinal canal, the spinal cord is in a state of long-term compression, and mild trauma can cause spinal cord injury bleeding The spinal cord is in a state of long-term compression, and a mild trauma can cause bleeding from spinal cord injury, resulting in paralysis. At the same time, due to degeneration of the cervical vertebral body peripheral bone superfluous formation, intervertebral joints and surrounding ligaments reduce elasticity and mobility, so that the occipito-cervical and atlanto-axial joint mobility relatively increased. In addition, the middle-aged and elderly patients are slow to react, the body’s stress capacity is reduced, easy to fall and lead to hyperextension injury. Therefore, this “whip-like” cervical spine injury in middle-aged and elderly people increases accordingly, and the degree of cervical spinal cord injury is often more serious than that of young people. Therefore, in daily life, if you experience headache, dizziness, neck and shoulder stiffness and other uncomfortable symptoms after a sudden emergency brake or rear-end collision, you should pay enough attention to it, and it is best to go to the hospital for examination as soon as possible to avoid delaying the condition. Diagnosis and treatment The incidence of cervical spine injury in middle and old age is gradually increasing and the morbidity and mortality rate is high, so active and special consideration should be given in diagnosis and treatment. The diagnostic criteria of cervical spine whip-like injury are not yet unified, but X-ray and CT examination can visually show whether there is fracture dislocation of the cervical spine after trauma, and can discover the underlying lesions of fracture-free cervical spine whip-like injury, such as spinal stenosis, disc herniation, ossification of the posterior longitudinal ligament, etc. It is an indispensable examination method for diagnosing fracture-free cervical spine dislocation cervical spine whip-like injury. Spinal stenosis should be considered when the sagittal diameter of the spinal canal is less than 12 mm on a lateral X-ray or when the ratio of the sagittal diameter of the spinal canal to the vertebral body is less than 0.75. Segmental cervical intervertebral instability can be diagnosed when the sum of the posterior edge angles of adjacent segments is >11° or the sum of horizontal displacement is >3.0 mm on a lateral cervical hyperextension/hyperflexion radiograph. MRI has good tissue resolution and plays an important role in the diagnosis of cervical spinal cord whip-like injury without fracture and dislocation, and can clearly show the different signal changes in the cervical intervertebral disc, anterior and posterior longitudinal ligaments, small cervical joint capsule, and the degree of anterior and posterior cervical soft tissue injury and spinal cord injury. MRI of spinal cord swelling and intramedullary edema shows slightly low signal on T1 image and high signal on T2 image, and the injured spinal cord is spindle shaped and enlarged; MRI of intramedullary hemorrhage or hematoma shows low signal on T1 image, round, spindle, oblong or irregular shape, and high signal on T2 image. Injuries to the high-risk cervical spine generally cause central spinal cord injury, mostly incomplete paraplegia. The severity of the injury is closely related to the size of the inertia of the fling, which is generally mild in terms of neck pain, hand pain and hand numbness, or in severe cases, resulting in tetraplegia. It is characterized by heavy symptoms in the upper extremities (especially the hands), and lighter symptoms in the lower extremities, and recovery also begins in the lower extremities, often ending up with numbness and uncomfortable movement of the hands. The aim of treatment for middle-aged and elderly whipple-like injuries is to reduce or prevent secondary damage to the cervical spinal cord and to maximize the conditions for recovery from spinal cord injury. Because the static stability of the cervical spine without fracture or dislocation is not affected, and stability can be restored by braking for a short period of time, the spinal cord function can be restored to varying degrees after conservative treatment, and the injury can even be completely restored in mild cases, so surgery was not advocated in the past. However, in recent years, the literature has reported that early surgical treatment of middle-aged and elderly patients with cervical whip-like injuries can prevent or reduce secondary damage to the spinal cord and promote recovery of spinal cord function. For middle-aged and elderly patients with whiplash-like injury, early surgery can not only improve the patient’s symptoms but also effectively reduce the occurrence of postoperative complications compared with conservative treatment followed by surgery. Prevention Particular attention should be paid to preventing accidental injury in middle-aged and elderly patients who have been identified as having a high-risk cervical spine. The trauma most likely to cause cervical spinal cord injury in high-risk cervical spine patients is hyperextension injury. A common hyperextension injury in everyday life is the injury sustained while sitting on the brakes in a car, and is even more dangerous when there is no pillow rest above the car seat. When the brakes are applied sharply, inertia often causes the head to move forward and then backward, and central bleeding can occur when the cervical spinal cord is hit by bone spurs and intervertebral discs in the narrow spinal canal. Therefore, do not drive fast when driving, but also to avoid braking hard. And do not doze off when sitting in a car, because the damage will be more serious if you fall asleep and lose your protective alertness. In short, middle-aged and elderly patients should raise awareness and pay attention to prevent neck trauma in daily life, such as wearing a neck brace, forbidding sleeping in the car, preventing falls, etc., so as to take precautions before they happen.