Spine Injury: Cervical, Adult



  • 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


  • 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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