Cervical spine fractures
Updates to Article Attributes
Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.
Epidemiology
Males are affected more commonly than females with the median age of injury being 56 years. In the paediatric population, upper cervical injury is more common with morbidity, it has been documented to be up to 18% 8. Falls, motor vehicle collisions, pedestrian accidents, cycling and diving are common causes of injury 6,7.
Pathology
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. C2 (~30%) and C7 (~20%) are the most commonly fractured levels 7.
There are many types of cervical spine fracture, some of which are unstable; general indicators of instability include:
- increased or reduced intervertebral disc space height
- increased interspinous distance
- facet joint widening
- vertebral compression >25%
- more than one vertebral column involvement ref required
Associations
Associated injuries are present in ~67% of patients 7:
- blunt cerebrovascular injury (BCVI) especially in high cervical fractures, those associated with subluxation and fractures involving the transverse foramen
- rib and/or sternal fractures
- the base of skull fractures
- facial fractures
Paediatric
The fulcrum of movement is different in children than adults, C2/3 compared to C5/6, respectively; hence, in children, cervical fractures are more common in upper vertebrae. There are also other anatomical differences of the cervical spine between children and adults which are worth bearing in mind while interpreting paediatric studies. These include more horizontal orientation of the facet joints in children, underdeveloped uncovertebral joints, mild physiological anterior wedging of the vertebral bodies, and incomplete ossification of the odontoid process.
Mechanism
The four major mechanisms are flexion, extension, rotational and shearing, each associated with certain fracture patterns 3,4:
- flexion: most ca common mechanism
- anterior atlantoaxial subluxation
- anterior subluxation (hyperflexion sprain)
- anterior wedge fracture
- clay-shoveler fracture
- flexion teardrop fracture
- bilateral facet dislocation
- hyperflexion fracture-dislocation
- lateral flexion
- unilateral occipital condyle fracture
- lateral l mass C1 fracture
- flexion-rotation
- extension
- hangman fracture
- extension teardrop fracture
- posterior arch C1 fracture
- posterior atlantoaxial subluxation
- extension-rotation
- axial loading/compression
- burst fracture (with axial loading)
- Jefferson fracture
- complex injuries
-<p><strong>Cervical spine fractures</strong> can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.</p><h4>Epidemiology</h4><p>Males are affected more commonly than females with the median age of injury being 56 years. Falls, motor vehicle collisions, pedestrian accidents, cycling and diving are common causes of injury <sup>6,7</sup>.</p><h4>Pathology</h4><p>The <a href="/articles/cervical-spine">cervical spine</a> is susceptible to injury because it is highly mobile with relatively small <a href="/articles/vertebral-bodies">vertebral bodies</a> and supports the head which is both heavy and acts as a lever. C2 (~30%) and C7 (~20%) are the most commonly fractured levels <sup>7</sup>.</p><p>There are many types of cervical spine fracture, some of which are unstable; general indicators of instability include:</p><ul>- +<p><strong>Cervical spine fractures</strong> can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading.</p><h4>Epidemiology</h4><p>Males are affected more commonly than females with the median age of injury being 56 years. In the paediatric population, upper cervical injury is more common with morbidity, it has been documented to be up to 18%<sup> 8</sup>. Falls, motor vehicle collisions, pedestrian accidents, cycling and diving are common causes of injury <sup>6,7</sup>. </p><h4>Pathology</h4><p>The <a href="/articles/cervical-spine">cervical spine</a> is susceptible to injury because it is highly mobile with relatively small <a href="/articles/vertebral-bodies">vertebral bodies</a> and supports the head which is both heavy and acts as a lever. C2 (~30%) and C7 (~20%) are the most commonly fractured levels <sup>7</sup>.</p><p>There are many types of cervical spine fracture, some of which are unstable; general indicators of instability include:</p><ul>
-<li><a href="/articles/base-of-skull-fractures">base of skull fractures</a></li>- +<li>the <a href="/articles/base-of-skull-fractures">base of skull fractures</a>
- +</li>
-<li>flexion: most common mechanism<ul>- +<li>flexion: most ca common mechanism<ul>
-<li>lateral mass C1 fracture</li>- +<li>lateral l mass C1 fracture</li>
-<a href="/articles/atlanto-occipital-dissociation-injuries">atlanto-occipital dissociation</a> (shearing)</li>- +<a href="/articles/atlanto-occipital-dissociation-injuries">atlantatlantooccipitalciation</a> (shearing)</li>
References changed:
- 8. Poorman GW, Segreto FA, Beaubrun BM, Jalai CM, Horn SR, Bortz CA, Diebo BG, Vira S, Bono OJ, DE LA Garza-Ramos R, Moon JY, Wang C, Hirsch BP, Tishelman JC, Zhou PL, Gerling M, Passias PG. Traumatic Fracture of the Pediatric Cervical Spine: Etiology, Epidemiology, Concurrent Injuries, and an Analysis of Perioperative Outcomes Using the Kids' Inpatient Database. (2019) International journal of spine surgery. 13 (1): 68-78. <a href="https://doi.org/10.14444/6009">doi:10.14444/6009</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/30805288">Pubmed</a> <span class="ref_v4"></span>