Spine Injury: Cervical, Adult

Basics

Description

Injury to the neck that results in injury to the spinal cord, cervical spine, or ligaments supporting the cervical spine
May have >1 mechanism concurrently
Flexion injuries:
- Simple wedge fracture: Usually a stable fracture
- Anterior subluxation: Disruption of the posterior ligament complex without bony injury; potentially unstable injury
- Clay shoveler's fracture: Avulsion fracture of the spinous process of C7, C6, or T1; stable fracture
- Flexion teardrop fracture: Extremely unstable fracture; may be associated with acute anterior cervical cord syndrome
- Atlanto-occipital dislocation: Unstable injury
- Bilateral facet dislocation: Can occur from C2–C7; unstable injury
Flexion/rotation injuries:
- Unilateral facet dislocation (“locked” vertebra): Stable injury
- Rotary atlantoaxial dislocation: Unstable injury
Extension injuries:
- Extension teardrop fracture: An avulsion fracture of the anteroinferior corner of the involved vertebral body; unstable in extension and stable in flexion
- Posterior arch of C1 fracture: Arch is compressed between the occiput and the spinous process of the axis during hyperextension; unstable fracture
- Avulsion fracture of the anterior arch of the atlas: Horizontal fracture of C1 and prevertebral soft tissue swelling on the lateral C-spine
- Hangman fracture: Traumatic spondylolisthesis of the axis involving the pedicles of C2; unstable fracture
- Hyperextension dislocation: Described as the syndrome of the paralyzed patient with a radiographically normal-appearing C-spine
Extension–rotation injury:
- Pillar fracture: Generally stable fracture
Vertical compression (axial loading) injuries:
- Jefferson fracture: Burst fracture of both the anterior and posterior arches of C1; extremely unstable fracture
- Burst fracture: A comminuted fracture of the vertebral body with variable retropulsion of the posterior body fragments into the spinal canal

Etiology

Blunt trauma is the major cause of neck injuries:
- Automobile accidents account for >50%
- Falls account for ∼20%
- Sporting accidents account for 15%
- Minor trauma in patients with severe arthritis may result in cervical injuries
Penetrating trauma

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