What is the cervical spine?
The cervical spine refers to the upper portion of the spine, consisting of 7 vertebral bodies that consists what we know as the neck. Subsequent vertebral bodies are separated by a gel-like disc that provides a cushion between the bones and facilitates the motion. The bones of the spine serve to protect the spinal cord and nerve roots, which branch off the spinal cord at each level and make up the nerves to the arms and hands. Also, there are ligaments in order to stabilize the whole system.
A cervical fracture refers to the breakage of one or more bones in the cervical spine while the term cervical dislocation explains the instability of the neck caused by the ligament injury in the neck which lead to separation of two (or more) of the adjoining spine bones from each other. Most injuries of cervical spine are the result of a violent collision that compresses the cervical spine against the shoulders. Patients can suffer from a cervical fracture or dislocation, or both. Fractures and dislocations of the cervical spine are not uncommon. The majority of fractures and dislocations of the spinal column occur in the cervical spine because this part of the spinal column is very mobile and therefore vulnerable to injury. Regardless of the cause, cervical spine fractures are serious injuries; they may involve spinal cord damage that can result in partial or complete paralysis or even death.
It is necessary to know that when you suspect that someone has a neck injury, you should immediately contact emergency medical services. You should not move the person yourself no matter how uncomfortable they look. Emergency medical technicians are trained in the proper treatment of people who have neck injuries. If you move a person who has a cervical spine fracture, you risk further injuring that person.
Motor vehicle accidents, falls, and accidents resulting from recreational activities are the leading causes of injuries to the lower cervical spine. Motorcycle accidents account for approximately 20% of motor vehicle accidents leading to spinal cord injuries. The incidence of falls leading to injury is higher in older persons (those aged 65 y and older). Spinal injuries have increased among skiers and snowboarders. The abrupt impact and/or twisting of the neck can cause the spine bones to crack or the ligaments to rupture, or both. The initial trauma or event may cause a cervical fracture and/or instability, which may also cause damage to the spinal cord and neurologic structures. The resultant spinal cord injury and neurologic deficit, if it occurs, is the most devastating aspect of a cervical injury, primarily because it is often irreversible and permanent.
Based on the severity and location of the injury, symptoms may consist of neck pain, stiffness, numbness and/or weakness in the arms and/or legs, and breathing difficulty. Signs are tenderness, spasm and decreased neck’s range-of motions, swelling and bruising of the site, step-off of the vertebrae, loss of strength and/or sensation, and diminished or absent deep tendon reflexes. Some other symptoms and sign may also be reported by the patient.
Cervical spine fractures and dislocations should always be suspected when a patient has been involved in a trauma or accident, especially those patients with neck pain. Plain x-rays of the cervical spine are essential to adequately evaluate a cervical fracture and dislocation. A CT scan is the best test to verify that a fracture is or is not present. Flexion/extension x-rays are often obtained, especially when no fracture is identified, but a patient has neck pain and was involved in large trauma or accident. Magnetic Resonance Imaging (MRI) is useful to estimate the severity of nerve compression, and should be performed before the reduction procedure, although it is less accurate than CT scan to detect a fracture.
There are two types of treatment approaches based on the location and the severity of injury: one is conservative or non-operative and the other is operative. Initial treatment of severe cervical fractures and dislocations may involve skeletal traction and closed reduction, with metal pins placed in the skull connected to a pulley, rope, and weights. Non-operative treatments include brace treatment and medications. Surgical treatments frequently involve posterior cervical fusion (mending the spine bones together) and instrumentation (small metal screws and rods stabilizing the spine). Other options include anterior (front of the neck incision) decompression and fusion, with or without instrumentation (metal plate and screws). Severely unstable fractures may require anterior and posterior neck surgery. The overall goals of treatment are to preserve or improve neurologic function, provide stability, and decrease pain. If these goals can be accomplished with conservative (non-operative) means, then that is generally preferred. However, because many cervical fractures and dislocations are highly unstable and will not adequately heal on their own, surgical stabilization is routinely performed.