Cervical Spine injuries by rakesh(presented on 11.11.10)

Cervical Spine InjuriesCervical Spine Injuries

RAKESH VALLITTAYILRAKESH VALLITTAYIL

BROKEN NECK-CAUSESCar 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.

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

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

Additional diagnosticAdditional diagnostic CT-scanCT-scan

Verified fracture, extent, encroachment, posterior Verified fracture, extent, encroachment, posterior complex (B-type !)complex (B-type !)

Suspicious area of trouble, not shown in conventional Suspicious area of trouble, not shown in conventional X-rayX-ray

MRIMRI Neurologic deficit without fracture – epidural hematomaNeurologic deficit without fracture – epidural hematoma Distraction injuries - posterior complexDistraction injuries - posterior complex Injuries of ligaments or disc (cervical spine), there is Injuries of ligaments or disc (cervical spine), there is

traumatic disc injury!traumatic disc injury! Differentiate old/new fracture (osteoporotic)Differentiate old/new fracture (osteoporotic)

Alignment Loss of cervical lordotisAlignment Loss of cervical lordotis indicating indicating ligmentous injury or occult ligmentous injury or occult

fracture fracture

Anterior vertebral line (anterior margin of vertebral bodies)Posterior vertebral line (posterior margin of vertebral bodies

Spinolaminar line (posterior margin of spinal canalPosterior spinous line (tips of the

spinous processes)

Prevertebral soft tissuePrevertebral soft tissue Disc spaces should be equal and symmetric Disc spaces should be equal and symmetric

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 and fractures occurs at anterior and posterior posterior

arches of the vertebraarches of the vertebra► Compression fracture of the bonyCompression fracture of the bony ring of first vertibra ring of first vertibra ► Displacement of lateral masses Displacement of lateral masses

splitting and transverse ligament splitting and transverse ligament tear.tear.

► Best seen on odontoid viewBest seen on odontoid view

► CT is required to define the extent CT is required to define the extent of fractureof fracture

TREATMENTTREATMENT

StabilityIntact or broken transverse ligament and degree of fracture of the anterior arch

Stable –soft or hard cervical collar ,traction

Unstable- fixation done

C2# ODENTOID FRACTUREC2# ODENTOID FRACTURE► odontoid fractures -most common upper cervical odontoid fractures -most common upper cervical

fractures.fractures.► Rule of thirds - 1/3- cervical cord Rule of thirds - 1/3- cervical cord 1/3- Dens 1/3- Dens

1/3- Empty 1/3- Empty► Flexion loading Flexion loading ► Majority of patients-results in anterior displacement Majority of patients-results in anterior displacement

of the dens.of the dens.► Extension loading (forward fall onto forhead) Extension loading (forward fall onto forhead) ► In minority of patients-results in posterior In minority of patients-results in posterior

displacement of the dens.displacement of the dens.

TYPE-I TYPE-I # through superior # through superior

portionportionAvulsion of Alar ligament Avulsion of Alar ligament Tmt: with semirigid collarTmt: with semirigid collar

TYPE-II # through the baseHyperextension or hyperflexion forcesAnterior screw fixation

TYPE-III # that extends into the body of C2Mechanically unstable 12 weeks of immobalization

C2#.Hangman’s C2#.Hangman’s FractureFracture

Sudden forceful hyperextension centered just under Sudden forceful hyperextension centered just under the chinthe chin

Mainly in deceleration injuries Mainly in deceleration injuries face or chin strike an unyielding objectface or chin strike an unyielding object with the neck in extension with 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 Traction Traction should not be givenshould not be given Surgery- Surgery- Reducing subluxation and stabilizing.Reducing subluxation and stabilizing. ORIF-oblique wiring and ORIF-oblique wiring and screw fixation.screw fixation.

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

‘Tear drop fracture’-fixation

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

Unilateral Facet DislocationUnilateral Facet Dislocation Due to flexion and rotatoryDue to flexion and rotatory movementsmovements Facet joint dislocation Facet joint dislocation Rupture of the apophyseal joint Rupture of the apophyseal joint ligaments ligaments Best seen on lateral or oblique viewsBest seen on lateral or oblique views

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.

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)

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

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