Cervical Spine Fracture / Trauma

A cervical spine fracture is a break in one or more of the 7 neck vertebrae; missed, an unstable fracture can cause permanent tetraplegia or death.

Mechanisms range from low-energy falls in older adults (often odontoid peg fractures) to high-energy sport, diving and road traffic injuries.

The Canadian C-spine rule identifies low-risk patients whose neck can be cleared clinically; everyone else is imaged, with CT first-line in adults.

The upper cervical spine (occiput, C1 and C2) provides most rotation, around 50% at the atlanto-axial joint. The dens of C2 sits within the ring of C1, held by the transverse atlantal ligament. The subaxial spine (C3 to C7) takes most axial load.

Stability is judged in cervical terms (transverse ligament, alignment, disc-ligament complex, facets, neurology) using the AO Spine and SLIC classifications; the Denis 3-column model is for thoracolumbar injuries.

Named injuries:

• •Jefferson fracture: C1 ring burst from axial load; stability depends on the transverse ligament
• •Hangman's fracture: bilateral C2 pars interarticularis, from hyperextension and distraction
• •Odontoid peg (Anderson and D'Alonzo types I to III): type II, at the base, is the commonest cervical fracture in older adults, often after a fall onto the forehead, and the most prone to non-union
• •Flexion teardrop: anteroinferior fragment with retropulsion and posterior ligament injury; unstable, often with cord injury
• •Extension teardrop: anteroinferior avulsion, usually in older patients and less serious
• •Bilateral facet dislocation: severe flexion injury with a high risk of cord injury
• •Unilateral facet dislocation (perched or locked): flexion-rotation, often with radiculopathy
• •Clay-shoveller's fracture: stable C7 or T1 spinous process avulsion