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Spine Injury: Cervical, Adult

Spine Injury: Cervical, Adult is a topic covered in the 5-Minute Emergency Consult.

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  • Injury to the neck that results in injury to the spinal cord, cervical spine, or ligaments supporting the cervical spine
  • May have more than 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


  • 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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Rosen, Peter, et al., editors. "Spine Injury: Cervical, Adult." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307374/all/Spine_Injury:_Cervical_Adult.
Spine Injury: Cervical, Adult. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307374/all/Spine_Injury:_Cervical_Adult. Accessed June 27, 2019.
Spine Injury: Cervical, Adult. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307374/all/Spine_Injury:_Cervical_Adult
Spine Injury: Cervical, Adult [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 June 27]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307374/all/Spine_Injury:_Cervical_Adult.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Spine Injury: Cervical, Adult ID - 307374 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307374/all/Spine_Injury:_Cervical_Adult PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -