eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics
Fracture, Cervical Spine: Multimedia
Updated: Oct 30, 2009
Multimedia
 | Media file 1: Odontoid fractures. (A) Type I odontoid fracture represents an avulsion of the tip of the dens at the insertion site of the alar ligament. Although mechanically stable, it is associated with life-threatening atlanto-occipital dislocation. (B) Type II odontoid fracture is a fracture at the base of the dens. This is the most common type of odontoid fracture. (C) With type III odontoid fracture, the fracture line extends into the body of the axis. |
 | Media file 2: (A) Simple wedge fracture with a flexion mechanism of injury is stable. (B) Flexion teardrop fracture with a flexion mechanism is unstable. |
 | Media file 3: Anterior subluxation with a flexion mechanism is stable in extension but potentially unstable in flexion. |
 | Media file 4: Bilateral facet dislocation with a flexion mechanism is extremely unstable and can have an associated disk herniation that impinges on the spinal cord during reduction. |
 | Media file 5: Clay shoveler fracture. (A) Lateral view of this fracture caused by a flexion mechanism shows that it is stable and represents an avulsion fracture of the base of the spinous process near the supraspinous ligament. (B) Anteroposterior view shows the vertically split appearance of the spinous process. |
 | Media file 6: Unilateral facet dislocation. (A) Lateral view of this fracture caused by a flexion-rotation mechanism shows that it is stable. Anterior displacement of spine is less than one half of the diameter of a vertebral body. (B) Anteroposterior view shows disruption of a line connecting spinous processes at the level of the dislocation. (C) Oblique view shows that the expected tiling of the laminae is disrupted, and the dislocated superior articulating facet of the lower vertebra is seen projecting within the neural foramina. |
 | Media file 7: Hangman fracture caused by an extension mechanism is unstable. Fracture line is evident in the lateral projection extending through pedicles of C2, along with disruption of the spinolaminar line. Sometimes, this fracture is associated with unilateral or bilateral facet dislocation, which makes it highly unstable. |
 | Media file 8: (A) Fracture of the posterior arch of C1 fracture caused by an extension mechanism is stable. Lateral projection shows a fracture line through the posterior neural arch without widening predental space. An odontoid view must be obtained to differentiate this benign fracture from a Jefferson fracture. (B) Jefferson fracture caused by a vertical (axial) compression mechanism is unstable. This fracture of all aspects of the C1 ring is associated with possible disruption of the transverse ligament of the atlas. Lateral projection may show a widened predental space and a fracture through the posterior arch of C1. Odontoid view shows displacement of the lateral masses of C1, allowing distinction of this fracture from a simple fracture of the posterior neural arch of C1. |
 | Media file 9: Burst fracture of vertebral body caused by a vertical (axial) compression mechanism is stable mechanically and involves disruption of the anterior and middle columns, with variable degree of protrusion of the latter. This middle column posterior protrusion may extend into the spinal canal and be associated with an anterior cord syndrome. |
 | Media file 10: (A) Normal lateral projection shows the relationships of anterior, posterior, and spinolaminar lines and prevertebral spaces. (B) Normal oblique projection shows the normal appearance of the laminae as shingles on a roof forming a regular elliptical curve with equal interlaminar spaces. |
More on Fracture, Cervical Spine |
| Overview: Fracture, Cervical Spine |
| Differential Diagnoses & Workup: Fracture, Cervical Spine |
| Treatment & Medication: Fracture, Cervical Spine |
| Follow-up: Fracture, Cervical Spine |
 Multimedia: Fracture, Cervical Spine |
| References |
| « Previous Page |
References
Trafton PG. Spinal cord injuries. Surg Clin North Am. Feb 1982;62(1):61-72. [Medline].
Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. Dec 25 2003;349(26):2510-8. [Medline]. [Full Text].
Mulkens TH, Marchal P, Daineffe S, Salgado R, Bellinck P, te Rijdt B, et al. Comparison of low-dose with standard-dose multidetector CT in cervical spine trauma. AJNR Am J Neuroradiol. Sep 2007;28(8):1444-50. [Medline].
Winslow JE 3rd, Hensberry R, Bozeman WP, Hill KD, Miller PR. Risk of thoracolumbar fractures doubled in victims of motor vehicle collisions with cervical spine fractures. J Trauma. Sep 2006;61(3):686-7. [Medline].
Davidson JSD, Birdsell DC. Cervical spine injury in patients with facial skeletal trauma. J Trauma. 1989;29:1276-1278. [Medline].
O'Malley KF, Ross SE. The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma. Oct 1988;28(10):1476-8. [Medline].
Sinclair D, Schwartz M, Gruss J, McLellan B. A retrospective review of the relationship between facial fractures, head injuries, and cervical spine injuries. J Emerg Med. Mar-Apr 1988;6(2):109-12. [Medline].
Hills MW, Deane SA. Head injury and facial injury: is there an increased risk of cervical spine injury?. J Trauma. Apr 1993;34(4):549-53; discussion 553-4. [Medline].
Duane TM, Dechert T, Wolfe LG, Aboutanos MB, Malhotra AK, Ivatury RR. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma. Jun 2007;62(6):1405-8; discussion 1408-10. [Medline].
Ellis GL. Imaging of the atlas (C1) and axis (C2). Emerg Med Clin North Am. Nov 1991;9(4):719-32. [Medline].
Hockberger RS, Kirshebaum KJ, Doris PE. Spinal injuries. In: Rosen P, Barkin R, Danzl DF, et al, eds. Emergency Medicine: Concepts and Clinical Practice. 4th ed. Mosby-Year Book; 1998:462-503.
Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. Jul 13 2000;343(2):94-9. [Medline].
Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. Am J Emerg Med. Oct 1997;15(6):591-5. [Medline].
Jacobs LM, Schwartz R. Prospective analysis of acute cervical spine injury: a methodology to predict injury. Ann Emerg Med. Jan 1986;15(1):44-9. [Medline].
Mahoney BD. Spinal injuries. In: Tintinalli JE, Krone RL, Ruiz E, eds. Emergency Medicine: A Comprehensive Study Guide. 4th ed. McGraw Hill Text; 1996:1147-1153.
National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury. Facts and Figures at a Glance. Birmingham, Ala: NSCISC; July 1996.
Nordin M, Carragee EJ, Hogg-Johnson S, Weiner SS, Hurwitz EL, Peloso PM, et al. Assessment of neck pain and its associated disorders: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine. Feb 15 2008;33(4 Suppl):S101-22. [Medline].
Proudfoot J, Pollack E, Friedland LR. Pediatric cervical spine injury: navigating the nuances and minimizing complications. Pediatr Emerg Med Rep. 1996;1(9):83-94.
Roberge RJ, Wears RC, Kelly M, et al. Selective application of cervical spine radiography in alert victims of blunt trauma: a prospective study. J Trauma. Jun 1988;28(6):784-8. [Medline].
Stassen NA, Williams VA, Gestring ML, et al. Magnetic resonance imaging in combination with helical computed tomography provides a safe and efficient method of cervical spine clearance in the obtunded trauma patient. J Trauma. Jan 2006;60(1):171-7. [Medline].
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. Oct 17 2001;286(15):1841-8. [Medline].
Velmahos GC, Theodorou D, Tatevossian R, et al. Radiographic cervical spine evaluation in the alert asymptomatic blunt trauma victim: much ado about nothing. J Trauma. May 1996;40(5):768-74. [Medline].
Further Reading
Keywords
cervical spine fractures, cervical spine injuries, cervical vertebrae, odontoid fractures, atlanto-occipital dislocation, simple wedge fracture, flexion teardrop fracture, bilateral facet dislocation, clay shoveler fracture, unilateral facet dislocation, rotary atlantoaxial dislocation, hangman fracture, extension teardrop fracture, posterior neural arch fracture, Jefferson fracture, burst fracture, atlas fractures, atlantoaxial subluxation, occipital condyle fracturecentral cord syndrome, fracture of the posterior arch of C1, pillar fracture, anterior cord syndrome, fracture of transverse process of C2, upper cervical spine injuries, occiput to C2 injuries, cervical orthosis, neurogenic shock
