Multiple level injuries of the cervical spine.

In a group of 105 patients admitted to hospital with injuries of the cervical spine, the incidence of injuries at multiple levels was 24 per cent. Multi-level injuries occurred in 17 out of 54 patients (31 per cent) sustaining a noteworthy neurological injury and in 8 out of 51 when such an injury was absent. This incidence is higher than previously reported, probably due to increasingly elaborate investigations. In the majority of cases, treatment of the dominant injury was unchanged by the demonstration of injuries at other levels, but in a small number, serious errors in treatment arose or could have arisen. Careful multi-level assessment, including assessment of the cervicothoracic junction, is indicated before selecting management. While conventional or computerized axial tomography may occasionally be necessary to achieve this, good conventional radiography remains the most important investigation. Computerized axial tomography is particularly useful in establishing the anatomy of complex injuries in the upper cervical spine.