Injuries to cervical spine

• Injuries to cervical spine are dangerous

and if associated with neurological
damage, the result can be devastating
• Jefferson pointed two areas commonly
involved in cervical spine injuries,C1
and C2 and C5 and c7
• According to Meyer C2 and C5 are
commonly involved
• Neurological damage is seen in 40% of
cases
• In 10% of cases ,radiographs are
• Causes :
• Fall from height: it is the most
common cause in devolping
countries
• Diving injuries: diving into water with
insufficient depth or in an inebriated
conditions
• Road traffic accidents: common
cause in developed countries
• Gunshot injuries
• Mechanism of injury
• Pure flexion force: compression
fracture of vertebral body e.g fall
from height
• Extension type: avulsion fracture of
superior margin of vertebral body:
whiplash injury
• Lateral flexion : fracture pedicle
fracture transverse process and facet
joints
• Clinical features:
• Pain
• Swelling
• Inability to move the neck
• Tenderness over the involved spinous
process
• There may be signs of neurological
involvement
• Concussion :
• This is a state of spinal shock and
there will be sensory loss, flaccid
paralysis ,visceral paralysis
• By 8 hours consussion is known to
regress and by 8-10 days is complete
recovery
• Nerve root involvement:
• Individual nerve roots could be
affected at their respective
intervertebral foramen
• All the features of peripheral nerve
injury will L.M.N type of lesion are
seen
• The myotome and dermatome should
be assesed to know the nerve root
• Cord involvement :
• Complete: this leads to quadriplegia
and quadriparesis
• Incomplete: here the central cord,
lateral cord ,anterior and posterior
cord are involved
• Investigations :
• Radiograph; lateral vies is important,
if and adequate lateral radiograph
reveals no fracture or dislocation
• Myelography
• CT scan
• MRI
• Treatment:
• At the accident site: resuscitation
and transport is important .
• In a person lying still without using
his neck after an RTA , a cervical
spine injury is always suspected until
proved otheriwse
• While taking to hospital all
unnecessary neck movement should
• At the hospital:
• Non operative treatment:
• Most cases can be treated non operatively
by halo vest and cervical collar
• Indications:
• Stable cervical spine with no neurological
signs
• Stable compression fracture of vertebral
bodies and undisplaced frature of laminae,
lateral masses or spinous process
• Unilateral facet dislocation reduced in
traction may be immobilized in a halo vest
• Skeletal traction:
• Reduction with traction is done for
unstable fracture
• Urgency of reduction is based on
neurological loss
• Traction is given for 3 to 6 weeks and
once satisfactory reduction is
achieved ,patient is mobilised with a
collar, corset or jacket
• Surgical treatment:
• Indications : unstable injury with or
without neurologic damage require
surgery
• Methods:
• In most patients early open reduction
and internal fixation is indicated to
obtain stability
• Cervical spine is stabilized usually
• Orthopedic goals:
• To restore the cervical spinal alignment
• To prevent future spinal deformity
• To prevent new neurological deficits
• To provide spinal stability
• Rehabilitation goals:
• To restore the normal or functional
range of neck movement with out
creating neurological injuryS
• Functional goals:
• To restore the flexibility of cervical
• Individual fracture:
• Fracture of C1: This is popularly known as
jefferson’s fracture.here the patient is
present with pain without neurological
deficit.
• Treatment
• For stable fracture rigid cervicothoracic
brace for three months
• Unstable fracture: open reduction and
posterior spinal fusion, skeletal traction or
• Physiotherapy management:
• First two weeks:
• Active ROM exercises are prescribed to the
upper and the lower limb muscles. no such
exercise to cervical region
• Isometric exercises are prescribed to the
abdominal quardiceps muscles but not for
cervical region
• Patient is taught bedrolling with assistance
,transfer and weight bearing with assistive
devices
• During this period the cervical spine remain
• After 2 weeks:
• The same regime is followed upto 8
weeks
• By 8 -12 weeks gentle active range
of movement to cervical spine are
begun
• Gentle passive movement to neck
after 12 weeks
• Isometric strengthening exercises are
• Rotary subluxation of C1 and C2:
• Patient is present with torticollis and
neck pain
• Treatment is usually by reduction and
tractionS
• Odontoid process fracture:
• Type 1: oblique fracture and its rare
and treated by cervical cast
• Type 2: junction of odontoid process
and body. Common with non union
rate of 36 %. Requires surgical
process and fusing
• Type 3: through upper part body of
the body of vertebra. Fracture unites
well with a halo cast