1. Cervical Spine InjuriesCervical Spine Injuries
RAKESH VALLITTAYILRAKESH VALLITTAYIL

2. BROKEN NECK-CAUSES
Car accidents,Falls,Sports,Violent acts (e.g., being shot)
The result can be catastrophic that is spinal cord injury resulting in
loss of sensation, paralysis, or death.

3. Stable fractures
•No spinal deformity or neurologic
(nerve) problems.
•Spine can still carry and distribute
weight
•Transverse ligament is intact
Unstable fractures
•Difficult for the spine to carry
and distribute weight.
•Progressing and causing
further damage.
•May also cause spinal
deformity

5. Imaging
 Following trauma or complaint of neck pain
 Obtain lateral, AP,and odontoid views
 Upper cervical spine
 transoral X-ray of odontoid process
 Cervico-Thoracic junction
 C6/7/T1, „Swimmer“, extension of the arms
 Statscan
 If there is any doubt of fracture, obtain
oblique(45 degress) views and consider CT

6. Additional diagnosticAdditional diagnostic
 CT-scanCT-scan
 Verified fracture, extent, encroachment, posteriorVerified fracture, extent, encroachment, posterior
complex (B-type !)complex (B-type !)
 Suspicious area of trouble, not shown inSuspicious area of trouble, not shown in
conventional X-rayconventional X-ray
 MRIMRI
 Neurologic deficit without fracture – epiduralNeurologic deficit without fracture – epidural
hematomahematoma
 Distraction injuries - posterior complexDistraction injuries - posterior complex
 Injuries of ligaments or disc (cervical spine), thereInjuries of ligaments or disc (cervical spine), there
is traumatic disc injury!is traumatic disc injury!
 Differentiate old/new fracture (osteoporotic)Differentiate old/new fracture (osteoporotic)

7. Alignment Loss of cervical lordotisAlignment Loss of cervical lordotis
indicatingindicating ligmentous injury or occult fractureligmentous injury or occult fracture
Anterior vertebral line (anterior margin of vertebral
bodies)
Posterior vertebral line (posterior margin of vertebral
bodies
Spinolaminar line (posterior margin of
spinal canal
Posterior spinous line (tips of the
spinous processes)

8. Prevertebral soft tissuePrevertebral soft tissue
Disc spaces should be equal and symmetricDisc spaces should be equal and symmetric

9. C1#.Jefferson FractureC1#.Jefferson Fracture
► Axial blow to the vertex of the headAxial blow to the vertex of the head
(e.g. diving injury, roof of the(e.g. diving injury, roof of the
vehicle).vehicle).
► fractures occurs at anterior andfractures occurs at anterior and
posteriorposterior
arches of the vertebraarches of the vertebra
► Compression fracture of the bonyCompression fracture of the bony
ring of first vertibraring of first vertibra
► Displacement of lateral massesDisplacement of lateral masses
splitting and transverse ligamentsplitting and transverse ligament
tear.tear.
► Best seen on odontoid viewBest seen on odontoid view
► CT is required to define the extent ofCT is required to define the extent of
fracturefracture

10. TREATMENTTREATMENT
Stability
Intact or broken transverse
ligament and degree of fracture
of the anterior arch
Stable –soft or hard cervical
collar ,traction
Unstable- fixation done

11. C2# ODENTOID FRACTUREC2# ODENTOID FRACTURE
► odontoid fractures -most common upper cervical fractures.odontoid fractures -most common upper cervical fractures.
► Rule of thirds - 1/3- cervical cordRule of thirds - 1/3- cervical cord
1/3- Dens1/3- Dens
1/3- Empty1/3- Empty
► Flexion loadingFlexion loading
► Majority of patients-results in anterior displacement of theMajority of patients-results in anterior displacement of the
dens.dens.
► Extension loading (forward fall onto forhead)Extension loading (forward fall onto forhead)
► In minority of patients-results in posterior displacement ofIn minority of patients-results in posterior displacement of
the dens.the dens.

12. TYPE-ITYPE-I
# through superior portion# through superior portion
Avulsion of Alar ligamentAvulsion of Alar ligament
Tmt: with semirigid collarTmt: with semirigid collar
TYPE-II
# through the base
Hyperextension or hyperflexion
forces
Anterior screw fixation
TYPE-III
# that extends into the body of C2
Mechanically unstable
12 weeks of immobalization

14. C2#.Hangman’s FractureC2#.Hangman’s Fracture
 Sudden forceful hyperextension centered just under theSudden forceful hyperextension centered just under the
chinchin
 Mainly in deceleration injuriesMainly in deceleration injuries
 face or chin strike an unyielding objectface or chin strike an unyielding object
with the neck in extensionwith the neck in extension
 # through the pedicle( pars reticularis)# through the pedicle( pars reticularis)
of C2 secondary to hyperextensionof C2 secondary to hyperextension
 Best seen on lateral viewBest seen on lateral view
 TractionTraction should not be givenshould not be given
 Surgery-Surgery-
 Reducing subluxation and stabilizing.Reducing subluxation and stabilizing.
 ORIF-oblique wiring andORIF-oblique wiring and
screw fixation.screw fixation.

15. Flexion Teardrop Fracture
 Most severe fracture of cervical
spine
 Unstable #
 Due to extreme flexion &
compressive forces
 Commonly results from a dive into
a shallow pool of water.
 Associated w/ acute anterior
cervical cord syndrome

16. ‘Tear drop fracture’-fixation

17. Bilateral Facet Dislocation
 Due to extreme hyperflexion
 Complete anterior dislocation of the vertebral body.
 Associated with a very high risk of cord damage.
 Best seen on lateral view

18. Unilateral Facet DislocationUnilateral Facet Dislocation
 Due to flexion and rotatoryDue to flexion and rotatory
movementsmovements
 Facet joint dislocationFacet joint dislocation
 Rupture of the apophyseal jointRupture of the apophyseal joint
ligamentsligaments
 Best seen on lateral or oblique viewsBest seen on lateral or oblique views

19. Anterior Subluxation
 Due to hyperflexion
 Distruption of posterior
ligamentous complex
 Signs:
 Loss of normal cervical lordosis.
 Anterior displacement of the
vertebral body.
 Fanning of the interspinous
distance.

20. Clay Shoveler’s Fracture
 # of Spinous process
 C6 to T 1
 Best seen on lateral view
 ‘Ghost sign’on AP view
( double spinous process of C6 or
C7)

21. Dynamic flouroscopy
 Ligamentous or spinal cord injuries
 No Radiological abnormality.
 Altered mental status after trauma.
 No bony involvement

22.  THANK YOUTHANK YOU