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
  • The 1st cervical vertebra has no body
  • The 2nd vertebra contains the odontoid process which allows 50% of neck rotation
  • C3–C7 can be conceptualized as a 3-column system: Anterior, middle, and posterior
  • Injuries of the occiput–C1–C2 complex:
    • Atlanto-occipital dislocation: Unstable injury. Twice as common in children
    • Atlas fracture:
      • Rarely associated with neurologic injury
      • Jefferson fracture: Fracture of both the anterior and posterior arches; extremely unstable fracture, 50% are associated with other C-spine injuries
    • Transverse ligament rupture (traumatic C1–C2 instability):
      • Rare, usually fatal injury
    • Atlantoaxial rotary subluxation-dislocation:
      • Unstable injury. Different types depending on the pivot point
    • Fractures of the odontoid process:
      • 5–10% of neurologic involvement
      • Type II has high nonunion rates
    • Hangman fracture:
      • Traumatic spondylolisthesis of C2
  • C3–C7 injuries:
    • Compressive-flexion:
      • Simple wedge fracture: Usually stable
      • Flexion teardrop fracture: Extremely unstable fracture; may be associated with acute anterior cervical cord syndrome
    • Flexion/rotation injuries:
      • Type II: Unilateral facet dislocation (“locked” vertebra): Stable injury
      • Type III–IV: Bilateral facet dislocation, unstable injuries
    • Extension injuries:
      • Vertebral arch fracture with or without anterior body displacement
    • Extension–distraction injuries:
      • Ligamentous complex failure
    • Vertical compression (axial loading) injuries:
      • Burst fracture: A comminuted fracture of the vertebral body with variable retropulsion of the posterior body fragments into the spinal canal
    • Miscellaneous cervical spine fractures:
      • Clay shoveler fracture: Avulsion fracture of the spinous process
      • Ankylosing spondylitis: “chalk stick” fractures after trivial injuries

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
    • Diving accidents
  • Penetrating trauma (gunshot injuries)

There's more to see -- the rest of this topic is available only to subscribers.