Overview
What is the prevalence of cervical spine fracture in unconscious patients in the ED?
How are cervical spine injuries classified?
What is the anatomy of spine relevant to cervical spine fracture?
What is included in the initial evaluation of a cervical spine injury?
When is radiographic evaluation indicated in the workup of cervical spine fracture?
What is included in the standard trauma radiography series for cervical spine fracture?
What is the role of CT scanning in the workup of cervical spine fracture?
What are the types of flexion cervical spine?
What is a simple wedge fracture of the cervical spine?
Which radiographic findings are characteristic of simple wedge fracture of the cervical spine?
What is a flexion teardrop fracture of the cervical spine?
What is an anterior subluxation of the cervical spine?
Which radiographic findings are characteristic of anterior subluxation of the cervical spine?
What is the prevalence of neurologic deficits due to anterior subluxation of the cervical spine?
What is a bilateral facet dislocation of the cervical spine?
Which radiographic findings are characteristic of bilateral facet dislocation of the cervical spine?
What is the prevalence of spinal cord injury in a bilateral facet dislocation of the cervical spine?
What is clay shoveler fracture of the cervical spine?
Which radiographic findings are characteristic of clay shoveler fracture of the cervical spine?
How are clay shoveler fractures of the cervical spine treated?
What are the types of cervical spine injuries caused by an extension mechanism?
What is a hangman fracture of the cervical spine?
Which radiographic findings are characteristic of a hangman fracture of the cervical spine?
How is a hangman fracture of the cervical spine treated?
What is extension teardrop fracture of the cervical spine?
What is a cervical spine fracture of the posterior arch of C1 (posterior neural arch fracture)?
What are upper cervical spine injuries?
What are the types of atlas fractures of the cervical spine?
What is atlantoaxial subluxation of the cervical spine?
What is atlanto-occipital dislocation of the cervical spine?
What are the types of odontoid process fractures of the cervical spine?
How are odontoid process fractures of the cervical spine treated?
What is occipital condyle fracture of the cervical spine?
How does mechanical instability affect a cervical spine injury?
How are cervical spine injuries ranked by degree of mechanical instability?
What is the prevalence of cervical spine fractures?
What are the types of flexion-rotation mechanism of the cervical spine?
What is a unilateral facet dislocation of the cervical spine?
How are unilateral facet dislocations of the cervical spine treated?
What are common injuries associated with vertical compression injury of the cervical spine?
What is a Jefferson fracture of the cervical spine?
Which radiographic findings are characteristic of a Jefferson fracture of the cervical spine?
What is a cervical spine burst fracture of the vertebral body?
How is a cervical spine burst fracture of the vertebral body treated?
Which cervical spine injuries are caused by multiple or complex mechanisms?
Presentation
What are the signs and symptoms of cervical spine fracture?
What causes cervical spine fractures?
What is spinal shock syndrome?
What are the signs and symptoms of neurogenic shock from a cervical spine fracture?
What are complete and incomplete cord syndromes?
What is anterior spinal cord syndrome?
What is central spinal cord syndrome?
What is Brown-Sequard syndrome?
What are high cervical spinal cord syndromes?
What is posteroinferior cerebellar artery syndrome?
What is the association of craniofacial injuries with cervical spine fracture?
What is the efficacy of a physical evaluation in the diagnosis of cervical spine injury?
Which physical findings are characteristic of cervical spine injury?
DDX
What are the differential diagnoses for Cervical Spine Fracture Evaluation?
Workup
What is the role of radiography in cervical spine fracture?
What is the role of a swimmer's view in the radiologic workup of cervical spine fracture?
What is the role of an oblique view in the radiologic workup of cervical spine fracture?
What is the role of an odontoid view in the radiologic workup of cervical spine fracture?
What is the role of an anteroposterior view in the radiologic workup of cervical spine fracture?
What is the role of CT scanning in the workup of cervical spine fracture evaluation?
What is the role of MDCT and MRI in the workup of cervical spine fracture evaluation?
Guidelines
What are the Canadian C-Spine Rules (CCR) for cervical spine fracture?
What are the ACOS recommendations for imaging cervical spine fracture?
How does the American Spinal Injury Association define cervical spine injury?
Medications
What is the role of medications in cervical spine fracture treatment?
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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.
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(A) Simple wedge fracture with a flexion mechanism of injury is stable. (B) Flexion teardrop fracture with a flexion mechanism is unstable.
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Anterior subluxation with a flexion mechanism is stable in extension but potentially unstable in flexion.
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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.
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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.
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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.
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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.
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(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.
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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.
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(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.