Cervical fracture dislocation

Cervical fracture dislocation

What is cervical spine fracture?

Symptoms of cervical Spine Dislocation:

What are the levels of the cervical spine?

What vertebral body is most commonly injured in cervical spine fractures?

Preventing Neck Fractures

Cervical Spine Dislocations treatment

How long does a cervical fracture take to heal?

Can a c2 fracture heal?

What is cervical spine fracture?

A cervical fracture means that a bone is broken in the cervical (neck) region of the spine. A cervical dislocation means that a ligament injury in the neck has occurred, and two (or more) of the adjoining spine bones have become abnormally separated from each other, causing instability. Patients can have a cervical fracture or dislocation, or both. Fractures and dislocations of the cervical spine are not uncommon, and account for almost half of all spinal column injuries that occur every year. According to a study published by Lasfargues in 1995, over 25,000 cervical fractures occur each year in the United States. The majority of fractures and dislocations of the spinal column occur in the cervical spine because it is the most mobile portion of the spinal column, and understandably, the most vulnerable to injury. Although the lumbar (low back) region is most commonly injured during daily laborious, low-energy activities, the neck is most likely to be injured during high-energy trauma such as motor vehicle accidents.

Cervical fractures and dislocations are typically classified according to their region/location and injury/fracture pattern. Because of the unique anatomy of the spine in the region close to the head, cervical injuries are categorized as occipital-cervical (occiput-C2) and subaxial cervical spine (C3-C7) injuries. Within each of these categories, injuries are further stratified according to the specific location of injury and injury/fracture pattern.

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Symptoms of cervical Spine Dislocation:

Symptoms of cervical spine dislocations include:

  • Intense pain in the neck
  • Pain that radiates down to the shoulders and arms
  • Numbness and tingling in the upper extremities
  • Weakness in the upper extremities
  • Stiffness in the upper extremities

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What are the levels of the cervical spine?

The neck is part of a long flexible column, known as the spinal column or backbone, which extends through most of the body. The cervical spine (neck region) consists of seven bones (C1-C7 vertebrae), which are separated from one another by intervertebral discs. These discs allow the spine to move freely and act as shock absorbers during activity.

Attached to the back of each vertebral body is an arch of bone that forms a continuous hollow longitudinal space, which runs the whole length of the back. This space, called the spinal canal, is the area through which the spinal cord and nerve bundles pass. The spinal cord is bathed in cerebrospinal fluid (CSF) and surrounded by three protective layers called the meninges (dura, arachnoid, and pia mater).

At each vertebral level, a pair of spinal nerves exit through small openings called foraminae (one to the left and one to the right). These nerves serve the muscles, skin and tissues of the body and thus provide sensation and movement to all parts of the body. The delicate spinal cord and nerves are further supported by strong muscles and ligaments that are attached to the vertebrae.

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What vertebral body is most commonly injured in cervical spine fractures?

Approximately 5-10% of unconscious patients who present to the ED as the result of a motor vehicle accident or fall have a major injury to the cervical spine. Most cervical spine fractures occur predominantly at 2 levels: one third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7. Most fatal cervical spine injuries occur in upper cervical levels, either at craniocervical junction C1 or C2.

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Preventing Neck Fractures

To help reduce your chance of getting a neck fracture, take these steps:

  • Avoid situations that put you at risk of physical harm.
  • Always wear a seatbelt when driving in a car.
  • Do not drive under the influence of alcohol or drugs.
  • Wear proper padding and safety equipment when participating in sports or activities.
  • Use proper tackling techniques in football. Do not spear with your helmet.
  • Never dive in the shallow end of a pool.
  • Never dive into water where you do not know the depth or what obstacles may be present.
  • Do weight-bearing exercises to build strong muscles and bones.

To help reduce falling hazards at work and home, take these steps:

  • Clean spills and slippery areas right away.
  • Remove tripping hazards such as loose cords, rugs and clutter.
  • Use non-slip mats in the bathtub and shower.
  • Install grab bars next to the toilet and in the shower or tub.
  • Put in handrails on both sides of stairways.
  • Walk only in well-lit rooms, stairs and halls.
  • Keep flashlights on hand in case of a power outage.

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Cervical Spine Dislocations treatment

  • Non-Surgical Treatments

Nonsurgical treatment is the first approach in patients with common neck pain not involving trauma. For example, many patients with cervical disc herniations improve with conservative treatment and time and do not require surgery. Conservative treatment includes time, medication, brief bed rest, reduction of strenuous physical activity and physical therapy. A doctor may prescribe medications to reduce the pain or inflammation and muscle relaxants to allow time for healing to occur. An injection of corticosteroids into the joints of the cervical spine or epidural space be used to temporarily relieve pain.

  • Surgery

The patient may be a candidate for surgery if:

  • Conservative therapy is not helping
  • Presence of progressive neurological symptoms involving arms and/or legs
  • Difficulty with balance or walking
  • In otherwise good health

There are several different surgical procedures that can be utilized, the choice of which is influenced by the specifics of each case. In a percentage of patients, spinal instability may require that spinal fusion be performed, a decision that is generally determined prior to surgery. Spinal fusion is an operation that creates a solid union between two or more vertebrae. Various devices (like screws or plates) may be used to enhance fusion and support unstable areas of the cervical spine. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe and chronic neck pain.

No matter which approach is taken, the goals of surgery are the same:

  • Decompress the spinal cord and/or nerves
  • Maintain or improve stability of the spine
  • Maintain or correct the spinal alignment

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  • Anterior Cervical Discectomy

This operation is performed on the neck to relieve pressure on one or more nerve roots or on the spinal cord. The cervical spine is reached through a small incision in the anterior (front) of the neck. If only one disc is to be removed, it will typically be a small horizontal incision in the crease of the skin. If the operation is more extensive, it may require a slanted or longer incision. After the soft tissues of the neck are separated, the intervertebral disc and bone spurs are removed and the spinal cord and nerve roots are decompressed. The space left between the vertebrae is filled with a small piece of bone or device through spinal fusion. In time, the vertebrae will fuse or join together across that level.

  • Anterior Cervical Corpectomy

The corpectomy is often done for cervical stenosis with spinal cord compression caused by bone spur formations that cannot be removed with a discectomy alone. In this procedure, the neurosurgeon removes a part or all of the vertebral body to relieve pressure on the spinal cord. One or more vertebral bodies may be removed, including the adjoining discs for multilevel disease. The space between the vertebrae is filled using a small piece of bone or device through spinal fusion. Because more bone is removed, the recovery process for the fusion to heal and the neck to become stable is generally longer than with anterior cervical discectomy. The surgeon may choose to support the anterior construct with posterior instrumentation and fusion, depending on the amount of spinal reconstruction required.

  • Posterior Microdiscectomy

This procedure is performed through a small vertical incision in the posterior (back) of your neck, generally in the middle. This approach may be considered for a large soft disc herniation that is located on the side of the spinal cord. A high speed burr is used to remove some of the facet joint, and the nerve root is identified under the facet joint. The nerve root needs to be gently moved aside to free up and remove the disc herniation.

  • Posterior Cervical Laminectomy and Fusion

This procedure requires a small incision in the middle of the back neck to remove the lamina. Removal of the bone is done to allow for removal of thickened ligament, bone spurs or disc material that may be pushing on the spinal cord and/or nerve roots. The foramen, the passageway in the vertebrae through which the spinal nerve roots travel, may also be enlarged to allow the nerves to pass through. Depending on the severity of the degeneration and amount of reconstruction required, the surgeon may determine that a posterior spinal fusion is needed in addition to the laminectomy to maintain proper spinal stability and alignment. This may reduce the risk of requiring future interventions at those levels.

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 How long does a cervical fracture take to heal?

Healing time varies by age and your overall health. Children and people in better overall health heal faster. In general, it may take several weeks to several months for a neck fracture to heal.

As you recover, you may be referred to physical therapy to keep your muscles strong. Do not return to activities or sports until your doctor gives you permission to do so.

It is possible that you may have permanent damage or paralysis even if your neck heals. If this is the case, you will need long-term rehabilitation.

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Can a c2 fracture heal?

In the case of the highest vertebrae, C1 and C2, this can mean almost complete paralysis. Compared to other types of spinal cord injury, damage in this area has the highest potential to cause a fatality. Successful repair of the broken parts of the bone can lead to excellent recoveries. The long-term prognosis is good. In some cases, the C2 and C3 vertebrae are fused together. In one study, fusion surgery done through the back of the neck proved to be 100 percent successful within six months.

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