Lower Cervical Spine Fractures and Dislocations Workup

  • Author: J Allan Goodrich, MD; Chief Editor: Mary Ann E Keenan, MD   more...
 
Updated: May 14, 2010
 

Laboratory Studies

  • Routine lab studies for trauma patients are included for those with subaxial cervical spine trauma. A complete blood count, urinalysis, and serum electrolyte levels and chemistries are obtained as the individual case dictates.
  • A blood type and screen or crossmatch for packed or whole blood may be necessary, depending on the concomitant injuries and vital sign assessment.
  • When spinal cord injury is present, neurologic impairment may impede evaluation of other injuries, including intra-abdominal trauma to solid organs. Liver and renal function testing may be of benefit in these situations.
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Imaging Studies

  • The cross table lateral radiograph is the criterion standard for evaluating subaxial cervical alignment. This must include visualization of the cervical-thoracic junction. A swimmer's view may be necessary to complete the evaluation of this area, but if body habitus precludes adequate visualization, a CT scan of the area is mandatory to exclude neck injury. Additional views include the anteroposterior (AP) and open mouth odontoid radiographs.[9, 10] Lateral film of a C5 burst/teardrop fracture. Lateral film of a C5 burst/teardrop fracture.
  • While a CT scan is helpful in imaging the cervicothoracic junction, it is extremely beneficial in identifying posterior column injuries such as lamina or facet fractures.[11] Sagittal CT scan of C5 burst fracture. Sagittal CT scan of C5 burst fracture. Axial CT scan of C5 burst fracture. Axial CT scan of C5 burst fracture. Axial CT scan of C7-T1 fracture/dislocation. Axial CT scan of C7-T1 fracture/dislocation. Sagittal CT of C7-T1 fracture/dislocation. Sagittal CT of C7-T1 fracture/dislocation.
  • MRI is particularly useful in demonstrating injuries to the neural elements, especially the spinal cord. Traumatic disk herniations are well delineated on MRI, but the routine use of this study may not contribute to the treatment regimen chosen for these injuries. If the neurologic level of injury does not match the area of injury identified by standard radiographs, this is another indication for MRI. Some have found MRI of the cervical spine to be helpful in determining ligamentous injury, but its application to justifying surgical intervention is not clear from available literature. MRI of C7-T1 fracture/dislocation. MRI of C7-T1 fracture/dislocation.
    • There is controversy on the management of unilateral and bilateral facet dislocations, because neurologic deterioration has been reported after closed reduction. Eismont suggested that the mechanism of this neurologic decline is cord compression at the time of reduction by large, associated disk herniations.[12] He recommended MRI evaluation prior to reduction, and if a large disk herniation is found, he proposed anterior removal prior to reduction as a means of avoiding a catastrophic event. This, however, remains debatable, as some surgeons believe delay in reduction in a neurologically incomplete or deteriorating patient is contraindicated and that reduction should be performed urgently.
    • If the patient is neurologically intact and alert, it seems reasonable to perform MRI scanning if not otherwise contraindicated. Each clinical situation must be assessed individually. In the patient with multiple injuries, including life-threatening injuries that need stabilization in the operating room, reduction could be performed without the delay necessary to obtain an MRI scan.
  • Magnetic resonance angiography may be indicated when associated vertebral artery injury is suspected. This may occur in the severely degenerative cervical spine or when fractures through the foramina transversarium are present.
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Contributor Information and Disclosures
Author

J Allan Goodrich, MD  Associate Clinical Professor, Department of Orthopaedic Surgery, Medical College of Georgia

J Allan Goodrich, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Thad Riddle, MD  Staff Physician, Department of Orthopedic Surgery, Cartersville Medical Center

Thad Riddle, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, and AO Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

K Daniel Riew, MD  Mildred B Simon Distinguished Professor of Orthopedic Surgery, Professor of Neurologic Surgery, Washington University School of Medicine; Chief, Cervical Spine Surgery, Department of Orthopedic Surgery, Barnes-Jewish Hospital

K Daniel Riew, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, AO Foundation, Cervical Spine Research Society, North American Spine Society, and Scoliosis Research Society

Disclosure: Medtronic Royalty Medtronic Vertex; Biomet Royalty Maxan anterior cervical plate; Osprey Royalty Interbody Graft; Osprey Stock Options None; SpineMedica None None; Synthes Consulting fee Other

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

William O Shaffer, MD  Professor, Vice-Chairman and Residency Program Director, Department of Orthopedic Surgery, University of Kentucky at Lexington

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, and Southern Orthopaedic Association

Disclosure: DePuySpine 1997-2007 (not presently) Royalty Consulting; DePuySpine 2002-2007 (closed) Grant/research funds SacroPelvic Instrumentation Biomechanical Study; DePuyBiologics 2005-2008 (closed) Grant/research funds Healos study just closed; DePuySpine 2009 Consulting fee Design of Offset Modification of Expedium

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Mary Ann E Keenan, MD  Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

References

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  10. Silva CT, Doria AS, Traubici J, Moineddin R, Davila J, Shroff M. Do additional views improve the diagnostic performance of cervical spine radiography in pediatric trauma?. AJR Am J Roentgenol. Feb 2010;194(2):500-8. [Medline].

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Cross-sectional anatomy of the cervical cord.
Normal anatomy of the lower cervical spine.
Lateral film of a C5 burst/teardrop fracture.
Sagittal CT scan of C5 burst fracture.
Axial CT scan of C5 burst fracture.
Reduction of C5 burst fracture after tongs traction.
Postoperative image of C5 burst fracture; note anterior and posterior fixation.
Postoperative image of C5 burst fracture.
Standard lateral cervical spine of an 80-year-old patient after a motor vehicle accident; patient has no neurologic deficits and no neck pain.
Swimmer's view of the same 80-year-old patient as in Image 9; note the C7-T1 fracture/dislocation.
Axial CT scan of C7-T1 fracture/dislocation.
Sagittal CT of C7-T1 fracture/dislocation.
MRI of C7-T1 fracture/dislocation.
Reduction of C7-T1 fracture/dislocation.
Postoperative anteroposterior view of C7-T1 fracture/dislocation.
Postoperative lateral view of C7-T1 fracture/dislocation.
 
 
 
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