Cervical spine fractures

Streitwieser DR, Knopp R, Wales LR, et al. (1983) Accuracy of standard radiographic views in detecting cervical spine fractures. Ann Emerg Med 12 538-542... 

Cervical spine fractures may result from translocation of the body and impact on landing or direct trauma arising from the impact of other translocated materials. Conventional treatment protocols should be followed. 

The most common type of injury due to combined tension and extension of the cervical spine is the whiplash syndrome. However, a large majority of such injuries involve the soft tissues of the neck, and the pain is believed to reside in the joint capsules of the articular facets of the cervical vertebrae [Wallis et al., 1997]. In severe cases, teardrop fractures of the anterosuperior aspect of the vertebral body can occur. Alternately, separation of the anterior aspect of the disk from the vertebral endplate is known to occur. More severe injuries occur when the chin impacts the instrument panel or when the forehead impacts the windshield. In both cases, the head rotates rearward and applies a tensile and bending load on the neck. In the case of windshield impact by the forehead, hangman s fracture of C2 can occur. Garfin and Rothman [1983] suggested that it is caused by spinal extension combined with compression on the lamina of C2, causing the pars to fracture. 

When a force is applied to the posterosuperior quadrant of the head or when a crown impact is administered while the head is in flexion, the neck is subjected to a combined load of axial compression and forward bending. Anterior wedge frartures of vertebral bodies are commonly seen, but with increased load, burst fractures and fracture-dislocations of the facets can result. The latter two conditions are unstable and tend to disrupt or injure the spinal cord, and the extent of the injury depends on the penetration of the vertebral body or its fragments into the spinal canal. Recent experiments by Pin tar et al. [1989, 1990] indicate that burst fractures of lower cervical vertebrae can be reproduced in cadaveric specimens by a crown impact to a flexed cervical spine. A study by Nightingale et al. [1993] showed that fracture-dislocations of the cervical spine occur very early in the impact event (within the first 10 ms) and that the subsequent motion of the head or bending of the cervical spine cannot be used as a reliable indicator of the mechanism of injury. 

Paediatric spinal trauma is an uncommon form of injury. Spinal injuries in children and adolescents account for l%-9% of total reported spinal injuries. Spinal fractures represent l%-2% of all paediatric fractures and the cervical spine is the commonest region involved accounting for 60%-80% of paediatric spinal injuries (Kokoska et al. 2001). This in turn means that the average general radiologist and emergency physician is unlikely to see a significant number of paediatric spinal injuries and may there-... 

The typical fractures in the sub-axial cervical spine are usually compression fractures of the vertebral body and facet fractures. 

Barba CA, Taggert J, Morgan AS, et al. (2001) A new cervical spine clearance protocol using computed tomography. J Trauma 51 652-656 discussion 656-7 Brant-Zawadzki M, Jeffrey RB Jr, Minagi H, et al. (1982) High resolution CT of thoracolumbar fractures. AJR Am J Roentgenol 138 699-704... 

Handel SF, Twiford TW Jr, Reigel DH, et al. (1979) Posterior lumbar apophyseal fractures. Radiology 130 629-633 Henderson RL, Reid DC, Saboe LA (1991) Multiple noncontiguous spine fractures. Spine 16 128-131 Hernandez JA, Chupik C, Swischuk LE (2004) Cervical spine trauma in children under 5 years productivity of CT. Emerg Radiol 10 176-178... 

Fig. 25.7a,b. Coronal volume-rendered multi-detector rowCT images in a patient with a high speed motorcycle accident to the upper cervical spine and the occipito-cervical junction, a Volume-rendering reconstruction with a low bone opacity shows a widening of the atlanto-axial junction as defined by a subluxation (arrows), which could not be detected in the axial source images, b Oblique coronal reformatted volumerendering reconstruction shows an additional fracture of the occipital condyles (arrowheads)... 

The pathological anatomy of traumatic deformities of the upper cervical vertebrae and articulations is based on the nature and mechanism of injury. Their treatment on the other hand, depends quite substantially on the presence and features of neurological deficits and pathological dislocations which can be hazardous to neural structures. The common traditional management of fractures and dislocations of the upper cervical spine are external immobilization or operative posterior fusion, or both. 

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