There are several cervical spine fracture classification systems. The literature on the diagnosis, classification, and treatment of. The incidence of traumatic cervical spine fractures csfx in the general population is largely unknown. Analysis of cervical spine injuries and mechanisms for ciren rollover crashes jon b. Cervical fractures usually result from highenergy trauma, such as automobile crashes or falls. There are several different types of spinal brace, below are three braces commonly used by north. Radiologic evaluation of spine cervical spine ap, lateral and open mouth to see the odontoid views swimmers view to see junction of c7 on t1 ct scan outstanding exam to view bone anatomy and. A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Fractures and dislocations of the cervical spine sciencedirect. Examples of common causes in humans are traffic collisions and diving into shallow water.
C1 and c2 hangmans fractures more common odontoid fractures evenly distributed younger patients have higher energy injuries ryan and henderson injury 1992. Geriatric odontoid fractures odontoid fractures are the most common cervical spine fracture in adults aged 70 years usually result of lowenergy, groundlevel fall head trauma extension injury blunt. Aug 22, 2009 there is a gradual change in the acceptability of halo jacket treatment for unstable cervical spinal injuries and much as the management of tibial fractures has migrated from a nonoperative treatment approach to operative stabilisation, there is a similar shift in trends for managing unstable cervical spine injuries. Geriatric odontoid fractures odontoid fractures are the most common cervical spine fracture in adults aged 70 years usually result of lowenergy, groundlevel fall head trauma extension injury blunt trauma patients 65 are 2x more likely to have c spine injuries than younger patients. Imaging manifestations of spinal fractures in ankylosing. Males are affected more commonly than females with the. If there are multiple levels, the most severe level is classified first. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures.
Subaxial cervical spine injury classification slic allen and ferguson. Cervical spine fracture classification systems radiology. On 3 sagittal and 1 axial cervical spine ct, grade iiiii anterolisthesis of c6 on c7, posterior elements fractures c6, bilateral jumped and locked facets with fractures traumatic c67 spondylolisthesis with bilateral locked facets bilateral locked facets. Geriatric odontoid fractures odontoid fractures are the most common cervical spine fracture in adults aged 70 years usually result of lowenergy, groundlevel fall head trauma extension injury blunt trauma patients 65 are 2x more likely to have cspine injuries than younger patients. On 3 sagittal and 1 axial cervical spine ct, grade iiiii anterolisthesis of c6 on c7, posterior elements fractures c6, bilateral jumped and locked facets with fractures traumatic c67 spondylolisthesis. How do you decide if your patient with cervical spine injury needs imaging.
Cervical fractures in dish or ankylosing spondylitis do not underestimate the. Ct with contrast myelography has an accuracy approaching 96% for diagnosis of cervical disc herniation. However, cervical fractures or fracture dislocations are rare, as evidenced by the relatively few cases identified in the literature, in the authors files, and by an analysis of nass 8090 data that revealed a cervical spine injury frequency. Clinical role of radiography for thoracic spine fractures. Radiologic evaluation of spine cervical spine ap, lateral and open mouth to see the odontoid views swimmers view to see junction of c7 on t1 ct scan outstanding exam to view bone anatomy and diagnose fractures flexionextension views. Case report successful surgical management of traumatic cervical. Up to 5% of spinal injuries have a second, possibly non adjacent, fracture. Dean and professor of surgery, university of toronto faculty of medicine toronto, ontario the recent revival of interest in the treatment of injuries of the spine has resulted from recognition that the adequate reduction of the displacement often leads to complete cure or at any rate to marked reduction in the residual dis. Head interaction with roof structures within the vehicle likely occurs during many rollover crashes, leaving the head and cervical spine vulnerable to compressive forces 2. Evidencebased diagnosis and treatment of cervical spine. Epidemiology of cervical spine fractures article pdf available in trauma monthly in pressin press march 2016 with 116 reads how we measure reads. These disorders include cervical spondylosis, cervical disk herniation, cervical stenosis, cervical myelopathy, spinal column instability. Pocketsized pdfs suitable for printing, lamination, and attachment to a lanyard.
Several reports describe the incidence of csfx in different subpopulations, such as. Currently, multidetector row ct mdct has been increasingly used for skeletal trauma patients. Neurological deficits from spinal cord injury are more frequent in spinal fracture patients with as than patients without. Several reports describe the incidence of csfx in different subpopulations, such as trauma center patients, specific age groups, head injury patients, military populations and osteoporotic patients 1 15. The cervical spine is susceptible to injury because it is highly mobile with relatively small vertebral bodies and supports the head which is both heavy and acts as a lever. Craniovertebral ligament testing current evidence on. X ray scan showed c23 discectomy and fusion, and anterior cervical plate fixation after operation. Axial loading of the cervical spine resulting from headdown contact is the primary cause of spinal cord injuries. If you continue browsing the site, you agree to the use of cookies on this website. Cervical spine trauma university of north carolina at. Twelve successive cases of spinal fractures were identified in mr imaging files. Oct 29, 20 cervical spine injuries cervical fractures by dr. C1 and c2 hangmans fractures more common odontoid fractures evenly distributed. Cervical spine fractures can occur secondary to exaggerated flexion or extension, or because of direct trauma or axial loading epidemiology.
Some fractures may be helped by a supportive brace. Fox foundation for parkinsons research dystonia is the third most common movement disorder, after essential tremor and parkinsons disease pd. Also known as traumatic spondylolisthesis of the axis result of hyperextension and distraction, classically after high speed mvc with chin hitting dashboard stable despite name, not commonly. Racgp upper cervical spine injuries in elderly patients. Gravity depends on the location, stability, and pattern of the injury. The vertebrae of the lower cervical spine have a superior cortical surface which is concave in the coronal plane and convex in the sagittal plane. Fractures of the cervical spine are potentially serious and devastating if not properly treated. Cervical spine fractures classification system 11 injuries are first classified by their level and primary injury type, either c, b, or a.
In the long term, physical therapy will be given to build strength in the muscles of the neck to increase stability and better protect the cervical spine. Cervical spine fractures, commonly known as broken neck, typically happen in highenergy traumas such as motor vehicle accidents, and account for the majority of fractures of the spinal column, as the cervical spine represents the part of the spine that is the most mobile and the most vulnerable to injury. Ct of the cervical spine ct scanning provides good visualization of bony elements and can be helpful in the assessment of acute fractures it can also be helpful when c6 and c7 cannot be clearly seen on traditional lateral radiographic views the accuracy of ct imaging of the cervical spine ranges from 7291% in the diagnosis of disc. Anderson and dalonzo classification odontoid fracture roycamille classification odontoid fracture levine and edwards classification for traumatic injuries to axis allen and ferguson classification subaxial spine injuries ao classification of upper cervical injuries. Nata position statement on headdown contact and spearing. Cervical spine trauma page 2 of 10 many now advocate ct for all trauma cases in which the cspine needs to be evaluated. These disorders include cervical spondylosis, cervical disk herniation, cervical stenosis, cervical myelopathy, spinal column instability, and fractures. The result of hyperflexion or hyperextension injuries. As a result, substantial numbers of fractures in the thoracic spine are overlooked compared to those in the cervical or lumbar spine 5, 7, 8, 10. Musculoskeletal spine, trauma, ct, mr, education, education and training. It is an overview for patients who have sustained a fracture break to the bones in the cervical spine neck area.
Prehospital see the naemsp national guidelines for spinal immobilization. Cervical spine fractures are potentially deadly conditions that arise after trauma, exaggerated extension or flexion. Cervical spine fractures musculoskeletal medicine for. Nov 09, 20 normal anatomy lower subaxial cervical spine. Imaging of cervical spine trauma cervical spine trauma. Anderson and dalonzo classification odontoid fracture roycamille classification odontoid fracture levine and edwards classification. This configuration allows flexion, extension, and lateral tilt by gliding motion of the facets. Patients with cervical fractures will likely be prescribed medication for pain control. Achieving the correct diagnosis and classification of a lesion is the. C spine fracture pattern junction bw cartilage endplate and bony vertebral body fractures split the endplate bw columnar growth cartilage and calcified cartilage does not typically occur by fracture through the endplate disc junction jones. The epidemiology of traumatic cervical spine fractures. Based on this finding, it is now recommended that any mvc patient found to have a cervical spine fracture should undergo complete spine imaging.
Your consultant will have discussed this option with you. Collars, traction and surgery can be used to immobilize and stabilize the neck after a cervical fracture. Physical exam palpation neck pain84% patients with a clinical exam and fracture have midline neck painstep off between spinous processes. They support the head and connect it to the shoulders and body. Subaxialcervical spine trauma pooriasalari, md assistant professor of orthopaedics department of orthopaedic surgery. Osteoporosis as a generalized bone disease appears to affect the cervical spine differently from other spinal regions. Aug 18, 2017 a recent association between cervical spine fractures and thoracolumbar spine fractures has been identified in victims of motor vehicle collisions mvc. Cervical x ray showed posterior c12 cervical pedicle screw and c3 lateral mass screws fixation at 1 year after operation. Cervical fractures this patient information has been designed to help give you information about your condition. Cervical x ray showed posterior c12 cervical pedicle screw and c3 lateral mass screws fixation after operation. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. Upper cervical spine trauma orthopaedic trauma association.
Diagram showing a side view of the spine the spinal column. Original article classification and surgical management for. Dystonia and parkinsons disease despite its prevalence, dystonia is underrecognized and therefore undertreated. This is a general guide and individual requirements may vary. Twelve successive cases of spinal fractures were identified in mr imaging files of as patients. There are several different types of spinal brace, below are three braces commonly used by north bristol nhs trust. Neurosurgery tower health medical group tower health medical group 601 spruce street west reading, pa 19611 phone. Anterocollis, especially when out of proportion in severity. As a result, substantial numbers of fractures in the thoracic spine are overlooked compared to those in the cervical or lumbar spine 5. Jun 18, 2017 supracondylar humerus fracture, pulseless hand everything you need to know dr. Clinical role of radiography for thoracic spine fractures in.
Kalaivanan kanniyan slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. Lower cervical spine fractures and dislocations clinical. Dean and professor of surgery, university of toronto faculty of medicine toronto, ontario the recent revival of interest. Fulcrum of movement is different in children than adults, c23 compared to c56, respectively. While cervical spine injury is more common in patients with multiple injuries, isolated injury may occur following comparatively minor traumatic incidents. Cervical spine collar clearance in the obtunded adult blunt trauma patient. Cervical spine trauma page 5 of 10 ct naked facets, small fracture fragments often not seen on radiographs cervical spine trauma flexion teardrop fracture most severedevastating flexion injury usually lower cervical spine c56 70% of cases diving accident shallow pool common cause.
If the patient is unable to be assessed using nexus ccsr then they will require radiological assessment. Cervical spine fractures radiology reference article. Ash1, jeff crandall1 abstract associated mechanisms of injuries sustained by rollover. Teardrop fracture extension upper cervical spine usually benign avulsion type flexion lower cervical spine anterior wedge or. The purpose of our investigation was to characterize spinal fractures and determine the value of different imaging modalities in as. Although the primary purpose of this document is advisory and educational, these guidelines are enforceable under the workers compensation rules of procedure, 7 ccr 1101 3. Basic principles of management for cervical spine trauma. Cervical spine fractures and osteoporosis springerlink. Mri of the cervical spine doctors of osteopathy do. However, cervical fractures or fracture dislocations are rare, as evidenced by the relatively few cases identified in the literature, in the authors files, and by an analysis of nass 8090 data that revealed a. A fracture, or break, in one of the cervical vertebrae is commonly called a broken.
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