Differential Diagnoses

Workup

Expert Panel on Neurological Imaging and Musculoskeletal Imaging. ACR Appropriateness Criteria^® Suspected Spine Trauma. J Am Coll Radiol. 2019 May. 16 (5S):S264-S285. [QxMD MEDLINE Link].
Kanwar R, Delasobera BE, Hudson K, Frohna W. Emergency department evaluation and treatment of cervical spine injuries. Emerg Med Clin North Am. 2015 May. 33 (2):241-82. [QxMD MEDLINE Link].
Guarnieri G, Izzo R, Muto M. The role of emergency radiology in spinal trauma. Br J Radiol. 2016. 89 (1061):20150833. [QxMD MEDLINE Link].
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. 2006 Sep. 61(3):686-7. [QxMD MEDLINE Link].
Duane TM, Dechert T, Wolfe LG, Aboutanos MB, Malhotra AK, Ivatury RR. Clinical examination and its reliability in identifying cervical spine fractures. J Trauma. 2007 Jun. 62(6):1405-8; discussion 1408-10. [QxMD MEDLINE Link].
Chilvers G, Janjua U, Choudhary S. Blunt cervical spine injury in adult polytrauma: incidence, injury patterns and predictors of significant ligament injury on CT. Clin Radiol. 2017 Aug 10. [QxMD MEDLINE Link].
Mandadi AR, Waseem M. Trauma, Spine, Spinal Injury, Pediatric. 2017 Jun. [QxMD MEDLINE Link]. [Full Text].
Pencle F, Mesfin F. Cervical, Disc Injuries. 2017 Jun. [QxMD MEDLINE Link]. [Full Text].
Asemota AO. Whats New in Emergencies, Trauma and Shock? Addressing Cervical Spine Fractures. J Emerg Trauma Shock. 2017 Jan-Mar. 10 (1):1. [QxMD MEDLINE Link].
Ivancic PC. Odontoid fracture biomechanics. Spine (Phila Pa 1976). 2014 Nov 15. 39 (24):E1403-10. [QxMD MEDLINE Link].
Shah K, Tikoo A, Kothari MK, Nene A. Current Concepts in Pediatric Cervical Spine Trauma. Open Orthop J. 2017. 11:346-352. [QxMD MEDLINE Link].
Kill C, Risse J, Wallot P, Seidl P, Steinfeldt T, Wulf H. Videolaryngoscopy with Glidescope Reduces Cervical Spine Movement in Patients with Unsecured Cervical Spine. J Emerg Med. 2013 Jan 22. [QxMD MEDLINE Link].
Aziz M. Use of video-assisted intubation devices in the management of patients with trauma. Anesthesiol Clin. 2013 Mar. 31(1):157-66. [QxMD MEDLINE Link].
Yue JK, Chan AK, Winkler EA, Upadhyayula P, Readdy WJ, Dhall SS. A review and update on the guidelines for the acute management of cervical Spinal Cord Injury (SCI) - part II. J Neurosurg Sci. 2015 Sep 9. [QxMD MEDLINE Link].
Darras K, Andrews GT, McLaughlin PD, Khorrami-Arani N, Roston A, Forster BB, et al. Pearls for Interpreting Computed Tomography of the Cervical Spine in Trauma. Radiol Clin North Am. 2015 Jul. 53 (4):657-74, vii. [QxMD MEDLINE Link].
Quarrington RD, Jones CF, Tcherveniakov P, Clark JM, Sandler SJI, Lee YC, et al. Traumatic subaxial cervical facet subluxation and dislocation: epidemiology, radiographic analyses and risk factors for spinal cord injury. Spine J. 2017 Jul 21. [QxMD MEDLINE Link].
INTERNATIONAL STANDARDS FOR NEUROLOGICAL CLASSIFICATION OF SPINAL CORD INJURY. American Spinal Injury Association. Available at http://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf. 2011; Accessed: August 18, 2017.
Cui LW, Probst MA, Hoffman JR, Mower WR. Sensitivity of plain radiography for pediatric cervical spine injury. Emerg Radiol. 2016 Jun 20. [QxMD MEDLINE Link].
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. 2000 Jul 13. 343(2):94-9. [QxMD MEDLINE Link].
Schleicher P, Scholz M, Kandziora F, Badke A, Brakopp FH, Ekkerlein HKF, et al. [Subaxial Cervical Spine Injuries: Treatment Recommendations of the German Orthopedic and Trauma Society]. Z Orthop Unfall. 2017 Jul 20. [QxMD MEDLINE Link].
Berritto D, Pinto A, Michelin P, Demondion X, Badr S. Trauma Imaging of the Acute Cervical Spine. Semin Musculoskelet Radiol. 2017 Jul. 21 (3):184-198. [QxMD MEDLINE Link].
Ning S, Yang S, Ding W, et al. Posterior atlantoaxial dislocation without fracture or neurological symptoms treated by transoral-posterior approach surgery: a case report and literature review. Eur Spine J. 2019 Jun. 28 (suppl 2):37-40. [QxMD MEDLINE Link].
Zhong J, Pan Z, Chen Y, et al. Postoperative cervical sagittal realignment improves patient-reported outcomes in chronic atlantoaxial anterior dislocation. Oper Neurosurg (Hagerstown). 2018 Dec 1. 15 (6):643-50. [QxMD MEDLINE Link].
Sun YH, Wang L, Ren JT, et al. Early reoccurrence of traumatic posterior atlantoaxial dislocation without fracture: a case report. World J Clin Cases. 2021 Feb 26. 9 (6):1461-8. [QxMD MEDLINE Link].
Li C, Li L, Li Z, et al. Surgical management for posterior atlantoaxial dislocation without fracture and atlantoaxial dynamic test to confirm the integrity of the transverse ligament: a case report. Orthop Surg. 2022 Feb. 14 (2):451-5. [QxMD MEDLINE Link].
Cloney M, Kim H, Riestenberg R, et al. Risk factors for transverse ligament disruption and vertebral artery injury following an atlas fracture. World Neurosurg. 2021 Feb. 146:e1345-50. [QxMD MEDLINE Link].
Starnoni D, Ecker T, Barges-Coll J. Navigation-assisted posterior open reduction and internal fixation in a C-CLAMP fashion for an isolated C1 fracture. J Neurol Surg B Skull Base. 2021 Feb. 82 (Suppl 1):S61-2. [QxMD MEDLINE Link].
Trafton PG. Spinal cord injuries. Surg Clin North Am. 1982 Feb. 62(1):61-72. [QxMD MEDLINE Link].
Hu J, Yang KH, Chou CC, King AI. A numerical investigation of factors affecting cervical spine injuries during rollover crashes. Spine (Phila Pa 1976). 2008 Nov 1. 33(23):2529-35. [QxMD MEDLINE Link].
Thompson WL, Stiell IG, Clement CM, Brison RJ. Association of injury mechanism with the risk of cervical spine fractures. CJEM. 2009 Jan. 11(1):14-22. [QxMD MEDLINE Link].
Donaldson WF 3rd, Hanks SE, Nassr A, Vogt MT, Lee JY. Cervical spine injuries associated with the incorrect use of airbags in motor vehicle collisions. Spine (Phila Pa 1976). 2008 Mar 15. 33(6):631-4. [QxMD MEDLINE Link].
Wang MC, Pintar F, Yoganandan N, Maiman DJ. The continued burden of spine fractures after motor vehicle crashes. J Neurosurg Spine. 2009 Feb. 10(2):86-92. [QxMD MEDLINE Link].
Stein DM, Kufera JA, Ho SM, Ryb GE, Dischinger PC, O'connor JV, et al. Occupant and crash characteristics for case occupants with cervical spine injuries sustained in motor vehicle collisions. J Trauma. 2011 Feb. 70(2):299-309. [QxMD MEDLINE Link].
Vanderlan WB, Tew BE, Seguin CY, Mata MM, Yang JJ, Horst HM, et al. Neurologic sequelae of penetrating cervical trauma. Spine (Phila Pa 1976). 2009 Nov 15. 34(24):2646-53. [QxMD MEDLINE Link].
Beaty N, Slavin J, Diaz C, Zeleznick K, Ibrahimi D, Sansur CA. Cervical spine injury from gunshot wounds. J Neurosurg Spine. 2014 Sep. 21(3):442-9. [QxMD MEDLINE Link].
Davidson JSD, Birdsell DC. Cervical spine injury in patients with facial skeletal trauma. J Trauma. 1989. 29:1276-1278. [QxMD MEDLINE Link].
O'Malley KF, Ross SE. The incidence of injury to the cervical spine in patients with craniocerebral injury. J Trauma. 1988 Oct. 28(10):1476-8. [QxMD MEDLINE Link].
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. 1988 Mar-Apr. 6(2):109-12. [QxMD MEDLINE Link].
Hills MW, Deane SA. Head injury and facial injury: is there an increased risk of cervical spine injury?. J Trauma. 1993 Apr. 34(4):549-53; discussion 553-4. [QxMD MEDLINE Link].
Leonard JC, Kuppermann N, Olsen C, Babcock-Cimpello L, Brown K, Mahajan P, et al. Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med. 2011 Aug. 58(2):145-55. [QxMD MEDLINE Link].
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. 2003 Dec 25. 349(26):2510-8. [QxMD MEDLINE Link]. [Full Text].
Buckland AJ, Bressan S, Jowett H, Johnson MB, Teague WJ. Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre. Emerg Med Australas. 2016 Jul 28. [QxMD MEDLINE Link].
Sharif S, Ali MYJ, Sih IMY, Parthiban J, Alves ÓL. Subaxial Cervical Spine Injuries: WFNS Spine Committee Recommendations. Neurospine. 2020 Dec. 17 (4):737-758. [QxMD MEDLINE Link].
Benayoun MD, Allen JW, Lovasik BP, Uriell ML, Spandorfer RM, Holder CA. Utility of computed tomographic imaging of the cervical spine in trauma evaluation of ground-level fall. J Trauma Acute Care Surg. 2016 Aug. 81 (2):339-44. [QxMD MEDLINE Link].
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. 2007 Sep. 28(8):1444-50. [QxMD MEDLINE Link].
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. J Manipulative Physiol Ther. 2009 Feb. 32(2 Suppl):S117-40. [QxMD MEDLINE Link].
Kumar Y, Hayashi D. Role of magnetic resonance imaging in acute spinal trauma: a pictorial review. BMC Musculoskelet Disord. 2016 Jul 22. 17:310. [QxMD MEDLINE Link].
Maung AA, Johnson DC, Barre K, Peponis T, Mesar T, Velmahos GC, et al. Cervical spine MRI in patients with negative CT: A prospective, multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). J Trauma Acute Care Surg. 2017 Feb. 82 (2):263-269. [QxMD MEDLINE Link].
Utz M, Khan S, O'Connor D, Meyers S. MDCT and MRI evaluation of cervical spine trauma. Insights Imaging. 2014 Feb. 5 (1):67-75. [QxMD MEDLINE Link].
Hagedorn JC 2nd, Emery SE, France JC, Daffner SD. Does CT Angiography Matter for Patients with Cervical Spine Injuries?. J Bone Joint Surg Am. 2014 Jun 4. 96(11):951-955. [QxMD MEDLINE Link].
Goode T, Young A, Wilson SP, Katzen J, Wolfe LG, Duane TM. Evaluation of cervical spine fracture in the elderly: can we trust our physical examination?. Am Surg. 2014 Feb. 80(2):182-4. [QxMD MEDLINE Link].
Small JE, Osler P, Paul AB, et al. CT cervical spine fracture detection using a convolutional neural network. AJNR Am J Neuroradiol. 2021 Jul. 42 (7):1341-7. [QxMD MEDLINE Link].
Athinartrattanapong N, Yuksen C, Leela-Amornsin S, et al. Prediction score for cervical spine fracture in patients with traumatic neck injury. Neurol Res Int. 2021. 2021:6658679. [QxMD MEDLINE Link].
Srinivas BH, Rajesh A, Purohit AK. Factors affecting outcome of acute cervical spine injury: A prospective study. Asian J Neurosurg. 2017 Jul-Sep. 12 (3):416-423. [QxMD MEDLINE Link].
Guyard T, Le Quellec A, Garrigues F, et al. Reproducibility and diagnostic value of a new method using ratios to diagnose anterior atlanto-axial subluxation on plain radiographs. Joint Bone Spine. 2021 Oct. 88 (5):105229. [QxMD MEDLINE Link].
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. 2008 Feb 15. 33(4 Suppl):S101-22. [QxMD MEDLINE Link].
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. 2006 Jan. 60(1):171-7. [QxMD MEDLINE Link].
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17. 286(15):1841-8. [QxMD MEDLINE Link].

Media Gallery

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.
(A) Simple wedge fracture with a flexion mechanism of injury is stable. (B) Flexion teardrop fracture with a flexion mechanism is unstable.
Anterior subluxation with a flexion mechanism is stable in extension but potentially unstable in flexion.
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.
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.
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.
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.
(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.
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.
(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.

of 10

Sections Cervical Spine Fracture Evaluation
Overview
Presentation
DDx
Workup
Guidelines
Medication
Questions & Answers
Media Gallery
References

Cervical Spine Fracture Evaluation Differential Diagnoses

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

What would you like to print?