Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlantoaxial dislocations, fractures of the odontoid process, and hangmans fractures in the c2 segment. Many subaxial cervical and upper thoracic spine fractures can be overlooked in the multiplyinjured trauma patient. Fractures of the cervical spine pubmed central pmc. A cervical fracture, commonly called a broken neck, is a catastrophic fracture of any of the seven cervical vertebrae in the neck. Gravity depends on the location, stability, and pattern of the injury. Most cervical spine fractures occur predominantly at 2 levels. Clinical evaluation of the cervical spine in a patient with blunt trauma is unreliable. A number of new developments in cervical spine imaging have transpired since the introduction of 64section computed tomographic ct scanners in 2004. Cervical spine fracture evaluation clinical presentation. The flexion teardrop fracture is a specific entity that should not be confused with other types of injury with a teardrop fragment. A cervical fracture is a break or crack that occurs in one of the three vertebral columns of the spine, called the cervical vertebrae. A subaxial cervical spine injury classification system was developed. Part 1, cervical spine and fracture fixation jonelle m. Cervical spine fracture an overview sciencedirect topics.
Types 2a and 3 require surgical reduction and internal fixation and must therefore be differentiated from types 1 and 2. Cervical spine fractures radiology reference article. Cervical spine fractures are potentially deadly conditions that arise after trauma, exaggerated extension or flexion. Osteoporosis as a generalized bone disease appears to affect the cervical spine differently from other spinal regions. The literature on the diagnosis, classification, and treatment of. Odontoid fractures are the most common cervical spine fracture in adults aged 70 years usually result of lowenergy, groundlevel fall head trauma extension injury blunt trauma patients 65 are 2x more likely to have cspine injuries than younger patients. The biomechanical stability of the spine is altered in patients with a rigid spine, rendering it vulnerable to fracture even from relatively minor impact. After the immediate trauma, there is a risk of spinal cord injury or worsening of an already injured spine if the fracture is unstable, that is, likely to change alignment without. If only facet injuries are identified no a, b, or c injury, they are listed first after the level of injury. Fractures of the cervical spine are potentially serious and devastating if not properly treated.
Concurrent upper cervical fractures are common and should be excluded. Thoracolumbar spinal fracture classification systems. They support the head and connect it to the shoulders and body. Upper cervical spine trauma orthopaedic trauma association. The posterior column remains intact, making this a stable fracture that requires only use of a cervical orthosis for treatment. These include odontoid fractures, posterior c1 arch fractures, and hyperextension teardrop fractures. An increasing body of evidence favors the use of multidetector ct as a standalone screening test for excluding cervical injuries in polytrauma patients with obtundation. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury resulting in loss of sensation, paralysis, or usually instant death. Cervical spine fractures and osteoporosis springerlink.
The procedure is performed to treat severe neck pain and disability, or instability of the cervical spine, and involves the use of bone graft materials and various types of instrumentation to join the. What are the types of atlas fractures of the cervical spine. Scis were queried and assessed according to upper c1c4 and lower c5c7 cervical spine levels. Cervical spine trauma is a common problem with a wide range of severity from minor ligamentous injury to frank osteoligamentous instability with spinal cord injury. A vertebral fracture is a break to one of the bones in your spine. Fulcrum of movement is different in children than adults, c23 compared to c56, respectively. These types of injuries can occur in athletes, car accident victims, or anyone who has undergone some form of acute neck strain or stress. The neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of the body. C1 and c2 hangmans fractures more common odontoid fractures evenly distributed younger patients have higher energy injuries ryan and henderson injury 1992. Classification and surgical management for the axis fracture. Cervical spine fractures occur in approximately 2% to 3% of blunt trauma patients. The c spine consists of seven vertebrae c1c7 and supports the weight of the head approximately 14 pounds.
Traumatic fracture of the pediatric cervical spine. The causes of injury included traffic injuries in 18 patients, fall injury. Multidetector ct of blunt cervical spine trauma in adults. The seven bones in the neck are the cervical vertebrae. American spinal injury association asia impairment scale ais classification of traumatic spinal cord injury. These types of fractures are typically medical emergencies that require urgent treatment. Accurate diagnosis of acute cervical spine injury requires cooperation between clinician and.
Cervical fractures usually result from highenergy trauma, such as automobile crashes or falls. This project describes a morphologybased subaxial cervical spine traumatic injury classification system. This article focuses on fractures of the thoracic spine midback and lumbar spine lower back that result from a highenergy event, such as a car crash or a fall from a ladder. Fractures of the thoracic and lumbar spine orthoinfo aaos. The rigid spine entities are ankylosing spondylitis as, diffuse idiopathic skeletal hyperostosis, degenerative spondylosis, and a. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. Flexion teardrop fracture of the cervical spine american journal. It is important to correctly classify the fracture to ensure appropriate treatment. The cervical spine neck region consists of seven bones c1c7 vertebrae, which are separated from one another by intervertebral discs. Cervical atlas, cervical vertebrae, spinal fractures, classification. Type i is an impact fracture of the occipital condyle for which the trauma. Subaxial fractures account for 40% to 60% of the cervical spine fractures. Using the same approach as the thoracolumbar system, the goal was to develop a comprehensive yet simple classification system with high intra and interobserver reliability to be used for clinical and research purposes.
The cervical spine is divided into the upper cervical spine occiputc2 and the lower cervical spine c3c7, according to anatomical differences. Spine and spinal cord injuries william schecter, md. Cervical spine ap, lateral and open mouth to see the odontoid. Type iv fracture, or jefferson fracture, is managed with cervical traction. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying. Cervical injuries can affect the muscles, nerves, and vertebrae of this region. Of these, it has been found that nearly 20% involve the c7t1 junction. Spine and spinal cord injuries san francisco general. Read more about symptoms, diagnosis, treatment, complications, causes and prognosis. Cervical spine injuries often involve permanent complete or partial loss of sensory function, and many associated complications. Teardrop fracture extension upper cervical spine usually benign avulsion type flexion lower cervical spine anterior wedge or quadrangular fragment flexion type. There are many different types of spinal fractures. Fracture types closedopen and cervical spine levels for varying years and age groups, surgical procedures, and surgical procedures for varying fracture levels were queried using icd9 codes. Examples of common causes in humans are traffic collisions and diving into shallow water.
Injuries to the cervical and thoracic spine can lead to neurological problems. Thoracolumbar spinal fracture classification systems are numerous and represent attempts by various authors to create systems that allow uniform and reproducible classification and description of thoracolumbar fractures which in turn can help with treatment decision making and prognostication despite numerous systems being proposed over the past century no universally accepted and clinically. The emergent evaluation of patients at risk relies on standardized clinical and radiographic protocols to identify injuries. Allen and ferguson classification of subaxial spine injuries typically used for research and not in clinical setting. Reference acr appropriateness criteria for suspected spine trauma acr 2018 pdf. In a study of surgical residents ability to predict cervical injuries on the basis of clinical examination alone, sensitivity and specificity were 46% and 94%, respectively. Teardrop fractures of the cervical spine are defined as fractures involving the anteroinferior angle of the cervical vertebral body, with the vertical dimension of the triangular fragment being equal to, or greater than the transverse dimension1. Approximately 510% of unconscious patients who present to the ed as the result of a motor vehicle accident or fall have a major injury to the cervical spine. The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and acts as a lever. A fracture, or break, in one of the cervical vertebrae is commonly called a broken neck. The vertebrae of the lower cervical spine have a superior cortical surface which is concave in the coronal plane and convex in the sagittal plane.
These discs allow the spine to move freely and act as shock absorbers during activity. Compression, burst, flexiondistraction, and fracture dislocation. Compression, burst, flexiondistraction, and fracturedislocation. Fracturedislocation at c6c7 and c7t1 with comminuted burst fracture to c7 and locked facet joint with resultant anterior migration of c6 over c7, unstable cervical spine fracture. A spinal fracture, also called a vertebral fracture or a broken back, is a fracture affecting the vertebrae of the spinal column. The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and. Most types of spinal fracture confer a significant risk of spinal cord injury. Initial management of types i, ii, and iii atlas fractures consists of placement of a cervical orthosis. Aospine subaxial cervical spine injury classification system.
1331 780 1010 130 808 1068 1002 439 619 278 927 723 1090 916 1239 296 1387 901 1462 1017 124 1147 470 1439 1377 121 926 123 35 926 1073 100 1279 1489 1448 101 674 474 1015 1148 674 153 22 1130 1394