What is Cervical Spine Fractures Overview?
The cervical spine is a flexible structure that protects the nervous system and enables movement of the head and neck. Neck fractures are a major cause of disability and death in accident victims and they are linked with 56% of neck spinal cord injuries. These fractures are often classified based on the specific part of the neck that is affected and are usually categorized into three groups: C1, C2 and the portion below the axis (from C3 to C7).
What Causes Cervical Spine Fractures Overview?
Cervical spine fractures happen when the spinal column moves in a way it’s not supposed to. This could involve extreme bending forward (hyperflexion), bending backwards (hyperextension), twisting (rotation), having a load force applied along the spine (axial loading), or bending side to side (lateral bending).
Risk Factors and Frequency for Cervical Spine Fractures Overview
Cervical spine fractures, or broken bones in the neck, can happen to people of all ages but are more commonly seen in males. These fractures often result from falls, making it the leading cause. Other causes include car accidents, biking mishaps, and injuries from diving. The rate of death from these fractures ranges from 5-10%.
- Cervical spine fractures happen to people of all ages but are more common in males.
- Falls are the most frequent cause.
- Other causes include car accidents, biking mishaps, and diving.
- The death rate from these fractures varies between 5% and 10%.
Signs and Symptoms of Cervical Spine Fractures Overview
When checking a patient with neck fractures, doctors begin by thoroughly examining basic trauma response, including the patient’s ability to breathe, their airway, and their circulation. This is because neck injuries can affect both breathing and heart function. Even after stabilizing these patients, they need to continue monitoring for possible changes in breathing and heart function.
Following this, doctors do a formal strength and sensation check on the patient’s arms and legs, and also check the muscle tone in their rectum. They then carefully examine the patient’s neck. This process often follows what’s known as the ASIA scoring system. It is crucial to identify severe spinal cord injuries as early as possible, because relieving pressure quickly (within 24 hours) can improve chances of nerve recovery.
Testing for Cervical Spine Fractures Overview
If you’re experiencing neck pain, deformity, swelling, confusion, a head injury, or neurological symptoms, you might need an imaging scan of your cervical spine. The cervical spine is the upper part of the spine that’s present in your neck. A Computed Tomography scan, commonly known as a CT scan, is usually the preferred method for this because it’s more sensitive than a regular X-ray for detecting any damage to the bones of your cervical spine. It’s about 98% sensitive as opposed to a 52% sensitivity rate of a typical X-ray.
An MRI, which stands for Magnetic Resonance Imaging, can provide more information about the ligaments in the spinal cord which can be important for understanding spinal stability and for planning if surgery is needed.
Doctors also use a scoring system to help guide if surgical or non-surgical management is best for neck injuries. This is often referred to as SLICS, or Subaxial Cervical Spine Injury Classification System. If a patient’s SLICS score ends up being 1 to 3, it usually means non-surgical treatment is best. If the score is 5 or more, surgery might be needed. A score of 4 is not clearly defined.
The SLICS system uses the following criteria to determine the score:
- Fracture Morphology (characteristics of the fracture)
- No abnormality – 0
- Compressed endplate disruption or fracture in the vertebral body – 1
- Burst fracture – 2
- Distraction – 3
- Rotation or translocation – 4
- Discoligamentous Complex (state of the disc and ligaments)
- Intact – 0
- Indeterminate – 1
- Disrupted – 2
- Neurological Status (condition of the nerves)
- Intact – 0
- Root injury – 1
- Complete spinal cord injury – 2
- Incomplete spinal cord injury – 3
- Continuous Cord Compression (consistent pressure on the spinal cord)
- With neurological deficit – 1
Treatment Options for Cervical Spine Fractures Overview
Injuries to the first and second cervical vertebrae (C1 and C2) make up about 30% of neck fractures. C1 fractures often occur in the lateral mass or arch and seldom lead to nerve damage due to the abundance of space around the spinal cord. If the fracture does not affect the transverse alar ligament (TAL), it can typically be managed with a stiff neck brace or a halo vest. However, if the TAL is damaged, surgery may be needed.
C2 fractures often affect the body, dens, or pars of the vertebrae. When a fracture affects both pars interarticularis, it’s known as a Hangman fracture. If such a fracture is minor, with less than 3mm of displacement or less than 11 degrees of angulation, a hard neck brace can be used for treatment. But if the fracture is more significant or if the injury involves the C2 to C3 disc, surgery might be necessary.
C2 fractures are categorized as type I, II, or III depending on the exact location of the injury. Type I fractures involve the tip of the dens, type II fractures affect the base of the dens, and type III fractures extend into the C2 vertebral body. Types I and III can usually be treated with a rigid neck brace, while type II fractures without high risk of nonunion can also be considered for this treatment. However, if a type II fracture has a high risk of nonunion – due to displacement of 5mm or more, an angle of more than 10 degrees, or if the patient is older than 50 – surgical treatment might be necessary. All C1-C2 fractures should be treated as unstable and should initially be managed with a hard neck brace before being evaluated for possible surgery.
Fractures of cervical vertebrae C2 to C7 follow similar patterns. Compression fractures result in loss of anterior vertebral body height without affecting the spinal canal or causing nerve injury. Burst fractures, a variant of compression fractures, cause the vertebral body to be pushed back into the cervical canal. Teardrop fractures are caused by neck flexion or flexion-extension and lead to a fracture in the lower front part of the vertebral body. Any fracture extending into the foramina transversarium from C2 to C6 should be evaluated for possible vertebral artery injury. Surgical intervention in such cases needs to take the SLICS scoring system into account.
Clay shoveler’s fractures refer to fractures of the cervical spinous processes. Any fracture should prompt the placement of a neck brace, and surgery may be needed to restore the curve of the neck, relieve the pressure on the spinal cord, or fix instability caused by ligament damage.
What else can Cervical Spine Fractures Overview be?
When a person is experiencing neck pain, the doctor will need to consider various potential causes before determining the final diagnosis. Here are some possible conditions that could be responsible:
- A sudden, sharp neck pain called acute torticollis
- Cauda Equina syndrome, a rare and severe type of spinal stenosis
- Strain in the neck muscles (Cervical strain)
- Injuries resulting from hanging
- Injury to the neck (Neck trauma)
- Severe infections leading to dangerously low blood pressure (Septic shock)
- Infections in the spinal cord
- Injuries to the spinal cord
- Tumors in the spinal cord (Spinal cord neoplasms)
- Tearing of the lining of your vertebral artery (vertebral artery dissection)
It’s essential that the doctor carefully examines the symptoms and carries out appropriate tests to provide the most accurate diagnosis.
