What is Cervical Injury?
Injuries to the cervical spine, or the neck area, might be rare but can lead to serious, long-lasting disability. The cervical spine has seven small bones called vertebrae which act as a shield for your spinal cord. It’s important to note that the neck area is prone to injuries due to its structure and flexibility.
What Causes Cervical Injury?
Understanding how an injury happened is key to figuring out what kind of injury a person might have. The most common reason for injuries to the neck (cervical injury) is trauma, which could be from car accidents, falls, injuries from sharp or blunt objects, or injuries from sports or diving.
However, there are also non-injury related causes. These include fractures due to bone weakening from osteoporosis (a condition where bones become weak and brittle), arthritis (a condition causing pain and inflammation in the joints), or cancer. Inflammation of the spinal cord can also lead to neck injuries.
The type of neck injury may vary according to the movement or impact at the time of the injury. It can occur due to bending (flexion), straightening (extension), twisting (rotation), bruising (contusion), or pressure (compression) of the spinal cord.
Risk Factors and Frequency for Cervical Injury
Cervical injuries, or injuries to the neck, are more frequent in males and usually happen to those between 15 to 30 years old or those over 65. In children under 15, they often happen due to car accidents, falls or sports injuries. These injuries typically occur in specific areas of the neck, known as the C2, C5, C6, and C7 regions.
- Cervical injuries happen more frequently in males.
- People aged 15 to 30 and those over 65 are most likely to experience these injuries.
- For children under 15, car accidents, falls, and sports injuries are the leading causes.
- The common areas of injury are the C2, C5, C6, and C7 regions of the neck.
Signs and Symptoms of Cervical Injury
A doctor’s examination can help identify a cervical or neck injury because many times, these can be detected in this way. Signs of a broken or displaced neck bone can be a stiff or painful neck. The doctor will thoroughly investigate how the injury happened and the patient’s condition afterwards.
A neck injury can sometimes harm the spinal cord. This possibility should be considered in patients who are unconscious, have neck pain or show signs of nerve damage. However, remember that even if there are no obvious signs of nerve damage, a spinal cord injury could still be present.
The doctor will perform an in-depth examination of the nervous system, which should include:
- Grading muscle strength, checking senses, and testing reflexes in the arms and legs
- Evaluating any tenderness, checking the movement range, and feeling for abnormal crackling sounds
The nerve examination is essential. Examining the neck nerves can help pinpoint the extent of the injury, whether there’s nerve compression, and where it’s located. Different parts of the neck control different functions. For example, C1 to C3 parts of the neck control head movements; C3 to C4 control the muscles that help us breathe and people with injuries in these areas might have trouble breathing; C5 to C7 control reflexes in the arms and certain types of movements. Symptoms like muscle weakness, loss of reflexes or sensation, or, in severe cases where C3 or C4 are involved, difficulty in breathing or even respiratory failure can indicate nerve damage.
The neck’s spinal column can be divided into two parts: a front part that contains the vertebral bodies, and a back part that holds the spinal cord. If the injury affects both these parts, the condition is considered unstable.
Testing for Cervical Injury
If your doctor suspects that you may have injured your neck, they will start by ensuring that you’re stable and able to undergo testing. They will use established protocols for severe injuries to ensure your safety. The initial testing for a suspected neck injury usually involves several different x-rays of your neck. These images should include views from the front and side of your neck as well as unique angled views and close-ups of the specific bone within your neck that connects directly to your spine.
According to the NEXUS Low-Risk Criteria, a well-accepted guideline in the medical community, your doctor might order x-rays of your neck if you’re experiencing things like tenderness in the middle of your neck, changes in your consciousness, alcohol or drug intoxication, a specific kind of injury elsewhere that’s so painful it might be distracting you from neck pain, or if you’re having any issues with neurologic functioning (things like numbness, weakness, or abnormal movements). These same guidelines also state that if you don’t have any of these symptoms or signs, you might not need an x-ray.
The Canadian C-Spine Rule is another accepted guideline doctors use to determine if neck x-rays are necessary. According to these guidelines, you would need x-rays if you’re over the age of 65, if you’ve been involved in hazardous events or if you experience tingling in your arms or legs. After that, if you’re not at high risk, your doctor would check if certain low-risk factors are present like being in a simple rear-end car crash or neck pain that started long after the injury happened. If none of these factors exist, then you would need an x-ray. Lastly, you would check if you can move your neck from side to side. If you can’t, then an x-ray would be recommended.
In more severe cases, like if your consciousness is impaired, you might have a CT scan since it provides a more detailed view than an x-ray. It’s only used when absolutely necessary due to the higher levels of radiation involved. If your x-ray appears normal, but you’re still having issues like numbness or weakness, your doctor might order an MRI. This type of scan can give a better view of the delicate nerves in your neck and where they might be compressed.
Neck injuries can be classified differently based on where they are on your spine. For instance, injuries from the base of your skull to your C2 vertebra (the second one from the top of your spine) are called occipital-cervical spine injuries. A wedge fracture can occur if your spine is bent far forward, while a burst fracture is a result of something pressing down on your spine from above. There are also specific fractures that involve different parts of your neck, such as Jefferson fractures and Hangman’s fractures. These can happen from various causes, including significant pressure to the back of your head or sudden stops. Your doctor will use the x-rays or scans they’ve taken to find out if you’ve had one of these specific injuries.
Treatment Options for Cervical Injury
If you have a severe neck injury, your immediate care will follow the advanced trauma life support (ATLS) protocols. These protocols are a series of checks and procedures designed to quickly identify and treat life-threatening injuries. Part of these protocols involves keeping your neck as still as possible, especially if you have to be moved, to avoid making the injury worse.
Managing your pain is another important part of your treatment. How the rest of your treatment proceeds depends on how severe your injury is.
If your neck injury is minor and has not affected your nervous system, you could be treated with non-surgical methods. This might involve pain relievers, wearing a neck brace for a while, and having regular check-ups to monitor your recovery. For more severe neck injuries that have made your neck unstable, surgery may be needed.
The type of surgery performed will depend on the specifics of your injury. For instance, if there’s a need to join together some of your neck bones (vertebrae), a process called fusion might be used. This could involve using metal plates and screws to keep the vertebrae together. Some neck injuries might need other kinds of devices, like a halo brace, to keep the vertebrae stable.
If your spinal cord or nerves are being squeezed, a procedure that makes more space might be necessary. This can involve removing some parts of your vertebrae. The goal is to relieve pressure on your spinal cord or nerves, and to keep your spine stable while you heal.
What else can Cervical Injury be?
Some conditions that may present with similar symptoms to certain neck and spinal issues include:
- Acute torticollis (sudden, painful neck stiffness)
- Cauda Equina syndrome (severe spinal nerve compression)
- Cervical strain (neck muscle strain)
- Hanging injuries
- Neck trauma
- Septic shock (a severe infection leading to dangerously low blood pressure)
- Spinal cord infection
- Spinal cord injuries
- Spinal cord tumors
- Thoracic outlet syndrome imaging (a test for a condition causing pain in the neck and shoulder, numbness and tingling of the fingers)