Cervical Spine Fracture Clinical Presentation
- Author: Moira Davenport, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Common presentations of cervical spine fracture include the following:
Posterior neck pain on palpation of spinous processes
Limited range of motion associated with pain
Weakness, numbness, or paresthesias along affected nerve roots
Clinical evaluation of the cervical spine in a patient with blunt trauma is unreliable. In a study of surgical residents' ability to predict cervical injuries on the basis of clinical examination alone, sensitivity and specificity were 46% and 94%, respectively. Because of these limitations and potential for catastrophic morbidity if injury is missed, most patients with complex blunt trauma seen in the ED undergo radiographic evaluation before clearance, with some exceptions.
Common findings on physical examination in cervical spine injury include the following:
- Loss of anal sphincter tone
- Fecal incontinence
- Loss of bulbocavernosus reflex
- Paradoxical bradycardia
- Flushed, dry, and warm peripheral skin
- Urinary retention
Motor vehicle collisions and falls account for 50% and 20% of cervical spine injuries, respectively. Recent studies have shown that the impact velocity at the time of a motor vehicle collision[3, 4] , airbag deployment on unrestrained drivers[5, 6] , drivers aged 65 years or older, and rollover mechanisms all significantly increase the likelihood of a cervical spine injury.
Sports-related activities account for 15%. The remaining injuries are attributed to interpersonal violence. The following athletic activities have the highest incidence of associated cervical spine injuries. Participants in these events should be considered at high risk.
Penetrating trauma rarely causes cervical spine fractures but may result in significant neurologic deficits. In one study of 144 cervical gunshot wounds, 40 were associated with neurologic deficits.
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