Overview
This lecture covers the types, mechanisms, and management of cervical spine fractures, with emphasis on injuries to C1 and C2 vertebrae and their clinical implications.
Types of Cervical Spine Fractures
- Occiput to C2 injuries can result in cranio-cervical dissociation, sometimes called internal decapitation.
- C1 (Jefferson) fracture is a fracture of the C1 ring, usually from axial loading.
- C2 (odontoid/dens) fractures involve the upward-projecting “tooth,” with type 2 fractures being most common.
- Hangman’s fracture is an explosive injury of the C2 ring, usually from axial loading and motion, causing instability but often sparing neurologic function.
- Burst fractures result from axial loading that explodes the vertebral body.
- Fracture-dislocations involve injury to all three spinal columns and are highly unstable.
Fracture Characteristics and Clinical Features
- Cranio-cervical dissociation often leads to severe brainstem injury affecting respiration and cardiovascular control; survival rates are improving with advanced trauma care.
- Hangman’s fractures often expand the spinal canal, which may reduce risk of neurologic injury but cause instability.
- Jefferson fractures typically occur without neurologic deficit but are unstable due to the disruption of C1 ring.
- Dens fractures can be managed with screws or posterior fusion depending on alignment and stability.
Management Approaches
- Instability or dislocation may require reduction, often attempted with Gardner-Wells tongs and weights while monitoring patient feedback.
- Some facet injuries (perched or locked) may require surgical reduction if closed methods fail.
- Ligamentous injuries may not appear on CT and often require MRI for diagnosis.
Other Notable Cervical Injuries
- Tear drop fractures result from axial loading and flexion.
- Spinous process fractures, known as “clay shoveler’s injuries,” are seen in hyperextension trauma.
- Disrupted posterior or interspinous ligaments are indicative of instability.
Key Terms & Definitions
- Axial Loading — Force applied along the axis of the spine, causing compression injuries.
- C1 (Atlas) — The topmost cervical vertebra; a ring-shaped bone supporting the skull.
- C2 (Axis) — Second cervical vertebra, featuring the dens (odontoid process).
- Jefferson Fracture — Burst fracture of the C1 ring from axial load.
- Odontoid (Dens) Fracture — Fracture of the upright “tooth” of C2.
- Hangman’s Fracture — Fracture through the neural arch of C2.
- Facet Joint — Joints between vertebrae that can become perched or locked in injury.
- Ligamentous Injury — Damage to the stabilizing ligaments of the spine.
Action Items / Next Steps
- Review spinal fracture classifications and their management.
- Study imaging examples of cervical spine injuries.
- Read about emergency reduction techniques and neurologic monitoring during reduction procedures.