Cervical Spine Injuries

CERVICAL SPINE
 CERVICAL SPINE
• Seven Cervical Vertebrae

• Eight pairs of Cervical spinal

nerves
Cervical Spine Injuries

Main Cause of the disease

TRAUMA
RTA – leading cause
 Mode of injury

• Road side accidents (RSA)

• Fall from height

• Accidental injury due to carrying heavy weight over head

• Sports injuries

• Trivial Trauma in Pre-existing Spondylotic spine

Mode of injury
 Mechanism of Injury
• NO STUDY TILL DATE WHICH CORELATES

SEVERITY OF INJURY WITH

MODE OF TRAUMA / INJURY

 Cervical Spine Injuries
Cervical spine injuries

with cord injury

without cord injury

 Cervical Spine Injuries
• PRESENTING COMPLAINTS

• Pain

• Quadriplegia
 Myotome and Dermatome Testing
Nerve Root Sensory Testing Motor Testing Reflex Testing
Level
C1-C2 Front of face Neck flexion N/A
C3 Lateral face and skull Lateral flexion N/a
C4 Supraclavicular Shoulder shrug N/A

C5 Lateral shoulder/upper arm Shoulder abduction Bicipital

(musculocutaneous)
C6 Lateral lower arm and hand Elbow flexion and Brachialradial
(thumb and index finger) wrist extension (musculocutaneous)
C7 Palmar aspect of hand – Elbow extension Triceps (radial)
middle 3 fingers and wrist flexion
C8 Medial lower arm and hand Finger flexion and N/A
thumb extension
T1 Medial elbow and upper arm Finger abduction N/A
DERMATOME DISTRIBUTION
 INVESTIGATIONS
• Radiological
• X-rays
AP, Lat , Swimmers view , odontoid view

• CT Scan

• MRI must for patients with neurological loss

DIGNOSTIC – PRE OPERATIVE
 X-RAYS
Lateral view
• Top of T1 visible in idle lat view
• Three smooth arcs maintained
• Vertebral bodies of uniform height
• Odontoid intact and closely applied to C1
AP view
• Spinous processes straight and spaced equally
• Intervertebral spaces roughly equal
Odontoid view
• Odontoid intact
• Equal spaces on either side of odontoid
• Lateral margins of C1 and C2 align
DIGNOSTIC – PRE OPERATIVE
CT SCAN MRI
 SIGNS OF INSTABILITY
• AP translation > 3.5mm
• spinous process widening on lateral
• rotation of facets on lateral

• facet joint widening

• malalignment of spinous process on AP view
• lateral tilting of vertebral body on AP view
LAT VIEW – X RAY
LAT VIEW – X RAY
Prevertebral soft tissue

Nasopharyngeal space
Retropharyngeal space
Retrotracheal space
AP and Odontoid View
 Initial Treatment
• CAB
• Immobilization
rigid cervical orthosis-
Philadelphia collar

Spine Board

cervical traction with Halo or

Gardner wells tongs.
 Initial Treatment
NO

YES
 Treatment - Conservative
Halo traction Gardner wells tongs
 Surgical Treatment
• Stabilisation

• Anterior
• Posterior
• Combined/ Global fusion
Surgical Treatment
Surgical Treatment
Surgical Treatment
Surgical Treatment
 Ferguson and Allen Classification
• Classification is Based on position of neck at time of injury
and dominant force

• Compression and Flexion

• Vertical Compression
• Distraction Flexion
• Compression Extension
• Compression Distraction
• Lateral Flexion
 Occipito-atlantal Dislocation
hyperextension distraction
and rotation of craniovertebral
junction

severe neurological injuries from

complete C1 quadriplegia to
incomplete syndromes
Surgical Treatment
 ATLAS FRACTURE
• Axial compression injuries
• neurological injury rare
• 3 types
Jefferson fracture- direct compression and lateral masses forced
apart
asymmetric load fracture ant or post to mass and displaces it
posterior arch fractures with an extension moment through it
 Jefferson Fracture
• Compression fracture of the
bony ring of C1

• Odontoid view

• Displacement of the lateral

masses of vertebrae C1 beyond
the margins of the body of
vertebra C2.
Jefferson Fracture
 Odontoid Fracture [Axis]
• 15 % all cervical fractures

• usually hyperflexion with anterior displacement

• assoc injuries to C1 common
• neurological deficit in 15-25% cases
 Odontoid Fracture

• Best seen on the lateral view

• Types
– I – Fx through superior portion of dens
– II – Fx through the base of the dens
– III – Fx that extends into the body of C2
Odontoid Fracture
Odontoid Fracture
 Odontoid Fracture
Type 1 - Philadelphia collar for 6-8 weeks

Type 2
undisplaced - halo immobilization
displaced - Primary C1-C2 fusion after reduction in traction [most
recommend if displacement > 4-5mm]

Type 3
Halo vest immobilization after reduction in traction ( 3-4 months)
 C2 Hangman’s Fracture
Fx through the pars reticularis of C2 secondary to hyperextension
 Hangman’s C2 Fracture
Traumatic spondylolithesis
• Type 1
isolated minimally displaced fracture of ring with no angulation

• Type 2
more unstable
flesion type/extension type or listhetic type
displaced > 3mm and angulation of C2-C3 disk space
ALL, PLL Disc can be interrupted

• Type 3
rare , anterior dislocation of C2 facets on C3 with 2 extension fracturing neural arch
Three types of Hangman’s fracture
 TREATMENT
• Type 1
Conservative - rigid cervical orthosis

• Type 2
– closed reduction with traction
– halo vest immobilization

• Type 3
– Surgical management - C2 -C3 fusion
 Clay Shoveler’s Fracture
• Fracture of a spinous process C6-T1

• Signs:
– Spinous process fracture on
lateral view.

– Ghost sign on AP view

(i.e. double spinous process of

C6 or C7 resulting from
displaced fractured spinous
 Burst Fracture

• Fracture of C3-C7
• axial compression.

• CT is required for all patients

to evaluate extent of injury.
 Wedge Fracture
• Compression fracture resulting
from flexion.

Buckled anterior cortex.

Loss of height of anterior

vertebral body.

Anterosuperior fracture of
vertebral body.
 DISLOCATIONS
Bilateral Facet Dislocation Unilateral Facet Dislocation
Cervical spine injuries with Vertebral artery occlusion
 Prevention is Better than Cure

When meditating over a disease, I never think of

finding a remedy for it, but instead, a means of

preventing it ”

Louis Pasteur
 Cervical Spine Injuries
…….. Known is a drop….
…………………..unknown is an
ocean………..

Dr. Kalaivanan Kanniyan

Assistant Professor – Orthopaedics
Arthroplasty and Adult Reconstruction Unit
SMCH, Saveetha University, chennai, Tamil Nadu, India.