Cervical Injuries & Conditions

The most common cervical spine injuries happen in athletic activities and motor vehicle collisions, with motor vehicle injuries being generally more severe. In athletes, there tends to be acute sprains and strains of the muscles of the neck. In motor vehicle accidents, there are whiplash injuries along with more severe injuries like disc injuries and fractures to portions of the vertebrae.

Cervical spinal injury kills 6000 people and leaves another 5000 as quadriplegics each year. Males get the condition four times more commonly than females. Only about two to three percent of those with a neck injury actually get a fracture. The most commonly injured vertebra is the second cervical vertebra, which makes up 24 percent of all fractures. The sixth and seventh vertebrae together account for a total of 39 percent of cervical fractures.

It is vitally important to promptly treat fractures, because 57 percent of these fractures are considered unstable and are therefore dangerous. Around 14 percent are clinically significant fractures that can lead to nerve damage if not treated correctly.

Age is a factor in getting cervical spinal injuries. Those older than 65 years have twice the risk of fracture as younger victims. Older people had a 24 percent higher mortality rate.

Most severe cervical spinal injuries are associated with motor vehicle accidents and many are associated with head injuries. Head injury patients are nearly four times as likely to have a C-spine injury and a high Glasgow Coma Scale (a measure of a patient’s level of consciousness).

Pathophysiology
Some cervical spinal fractures are named, such as the Jefferson and the hangman fractures. There is also a fracture called an axial compression fracture, of which the Jefferson fracture is one type. It is an unstable burst fracture of the atlas caused by severe axial blows. A diving injury is one of these types of fractures. The vertebra C1 is fractured along two sides. This is a very unstable fracture.

Odontoid fractures are of three separate types. They can be due to forceful flexion, extension and rotation of the neck. A Type I fracture involves an avulsion of the tip of the dens (part of the second cervical vertebra) above the transverse ligament. This is not an unstable fracture, but it can be associated with a dislocation of the alanto-occipital area. This is vitally dangerous and must be ruled out as soon as possible.

Type II odontoid fractures are the most common and are localized near the base of the dens. It is a very unstable injury from which many people die. Patients often need surgery to repair it because the dens has a poor blood supply and doesn’t heal well on its own. If there is a displacement of the dens fracture by 6 mm, it will represent a 67 percent rate of nonunion.

A type III fracture extends into the body of C2 and is unstable. It is very dangerous but nonunion is unusual. Most people are treated with halo and immobilization.

Flexion Injuries
There are two very dangerous and unstable flexion injuries of the cervical spine. One is the flexion teardrop fracture and the other is the bilateral facet joint dislocation. The flexion teardrop injury is particularly dangerous and is common in motor vehicle accidents and diving accidents. It is common to have neurological injury including quadriplegia, loss of pain, and loss of temperature sensation. The vertebra most commonly receiving a teardrop fracture is C5.

The bilateral facet joint dislocation is the most severe type of anterior subluxation (joint dislocation). It results in disruption of ligaments and subluxation of greater than fifty percent on lateral plain film. It is common to have some type of neurological injury.

Extension Injuries
This includes the hangman’s fracture of the second cervical vertebra and can happen during a car accident or a diving injury. This is an unstable fracture. An extension teardrop is sometimes unstable and sometimes stable. It is caused by hyperextension of the neck. Fortunately, the neurological damage is not a severe as in other fractures.

If the injury is described as a strain, this means that the muscle-tendon unit is overloaded or stretched. The muscles often strained include the rhomboids, trapezius muscles, the scalenes, the levator scapulae or the erector spinae muscles. This is a muscle injury for the most part and, while sore, gets better with rest and ice/heat to the affected area.
If the injury is a sprain, it means that a ligament has been pulled, stretched or lacerated. A ligament is an attachment between two bones that often hold a joint together. There are multiple ligaments in the cervical spine. It may be hard to differentiate a cervical sprain from a strain but your doctor can help differentiate between the two.

There are several other possible types of cervical injury. These include the following:

  • Brachial Plexus injury—an injury to the nerves that come out of the spinal cord
  • Cervical disc injury—this damages or ruptures the cushions between the vertebrae
  • Atlantoaxial injury—this can be a serious injury involving the base of the skull and the spine
  • Cervical facet syndrome—this involves an injury to the joints between parts of the vertebrae
  • Myofascial pain—this involves damage to the muscles and connective tissue
  • Cervical radiculopathy—this is when one or more nerves are pinched at the level of the spinal canal or spinal outlet