II. Anatomy
- See Cervical Spine Anatomy
- Image: Cervical Vertebrae
Lewis (1918) Gray's Anatomy 20th ed (in public domain at Yahoo or BartleBy)
- Three-Column Model
- Anterior column
- Anterior half of Vertebral body
- Anterior ligamentous complex
- Anterior portion of annulus fibrosus
- Anterior longitudinal ligament
- Middle column
- Posterior half of Vertebral body
- Ligaments
- Posterior portion of annulus fibrosus
- Posterior longitudinal ligament
- Posterior Column
- Facet joints (superior and inferior articular process)
- Laminae
- Spinous processes
- Posterior ligamentous complex
- Facet capsules
- Interspinous ligaments
- Anterior column
III. Types: C1 Fractures
- Mechanism
- Axial load or Hyperextension injuries
- Jefferson Fracture (most common)
- Bilateral burst Fracture through posterior arch and lateral aspects
- Neurologic function is often spared
IV. Types: C2 Fractures
- Arch Fractures (hyperextension injury)
- Hangman's fracture (now typically due to MVAs)
- Fracture through both arches, pedicles
- C2 is dislocated from C1, and C2 subluxes anteriorly on C3
- Hangman's fracture (now typically due to MVAs)
- Odontoid Fractures (forced flexion or extension)
- Fracture at junction of odontoid and Vertebral body
- Surgically managed
- Fracture of the odontoid tip
- Managed with Cervical Collar immobilization
- Fracture at junction of odontoid and Vertebral body
V. Types: Facet Dislocation
- Unilateral facet dislocation
- Bilateral facet dislocation
- Severe flexion force to the middle and Posterior Columns
- Vertebral subluxation >50% of Vertebral body width
- Unstable injury
VI. Types: Wedge Compression Fracture
- Mechanism
- Flexion loading of the spine (even minor forces)
- Anterior Vertebral body end plate compression
VII. Types: Flexion Teardrop Fracture
VIII. Types: Translation-Rotation Fracture
- Severe, unstable injury almost always requiring Spine Surgery
- Mechanism
- Displacement of a Fracture in the horizontal plane (left-right, anterior-posterior or rotational)
- Findings
IX. Types: Burst Fracture
- Mechanism
- Flexion and compression injury (e.g. diving)
- Comminuted Vertebral Fracture
- Disrupts anterior and middle columns
- Typically involves middle and lower Cervical Vertebrae
- Spinal Cord Injury if fragments are displaced
- Findings
- Vertebral height loss
- Posterior Ligamentous Complex Injury
X. Types: Spinous Process Fracture
- Mechanisms
- Direct spinous process Trauma
- Sudden deceleration
- High velocity Trauma with neck flexion
- Severe Muscle Contraction with secondary avulsion
- Spinous process tip avulsion (Clay Shoveler's Fracture)
XI. Imaging
XII. Management
- See Cervical Spine Injury
- See Cervical Spine Immobilization
-
Vertebral Fracture Stability
- Consider any cervical Vertebral Fracture unstable with the exception of those listed below
- Subaxial Injury Classification and Severity Scale (SLICS)
- Unstable Cervical Spine Fracture (Mnemonic - "Jefferson Bit Off A Hangman's Tit")
- J - Jefferson Fracture (C1 Burst Fracture, axial loading injury)
- B - Bifacet dislocation or Fracture (flexion injury)
- O - Odontoid Fracture (Types 2 and 3, flexion injury)
- A - Any Fracture-dislocation, Atlantoaxial dislocation or atlanto-occipital dislocation (flexion injury)
- H - Hangman's fracture or bilateral C2 Pedicle Fracture (posterior C2 Fracture, extension injury)
- T - Teardrop Fracture (extension or flexion injury)
- Stable Fractures
XIII. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Eiff and Hatch (2018) Fracture Management for Primary Care, p. 187-96
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
ICD10 | S12 , S12.9 |
SnomedCT | 207982008, 125606003 |
English | Fracture of neck, part unspecified, Fractured cervical spine, Fracture of neck NOS, Fracture of cervical vertebra NOS, fracture of neck, Fracture of cervical spine NOS, cervical spine fracture, cervical vertebra fracture, fracture neck, Fracture;cervical, cervical fractures, fracture neck of, neck fracture, Fracture;neck, fractures neck, cervical fracture, cervical fractures spine, fracture cervical, fracture cervical vertebra, Cervical vertebral fracture, fracture of cervical spine (diagnosis), Fracture of cervical spine, Fracture of neck, Fracture of cervical spine (disorder), Fracture of cervical vertebra, cervical; fracture, fracture; cervical, fracture; neck, fracture; spine or vertebra, cervical, fracture; vertebra, cervical, neck; fracture, spine or vertebra; fracture, cervical, fracture of cervical spine, fractured neck |
Italian | Frattura della vertebra cervicale, Colonna cervicale fratturata |
Dutch | gefractureerd cervicale wervelkolom, cervicaal; fractuur, fractuur; cervicaal, fractuur; hals, fractuur; wervel, cervicaal, fractuur; wervel{kolom}, cervicaal, hals; fractuur, wervel{kolom}; fractuur, cervicaal, Fractuur van hals, deel niet gespecificeerd, halswervelbreuk, Fractuur van hals |
French | Rachis cervical fracturé, Fracture de vertèbre cervicale |
German | Fraktur der Halswirbelsaeule, Fraktur im Bereich des Halses, Teil nicht naeher bezeichnet, Fraktur im Bereich des Halses, Fraktur eines Halswirbels |
Portuguese | Coluna vertebral fracturada, Fractura de vértebra cervical |
Spanish | Columna cervical fracturada, fractura de las vértebras cervicales, fractura de la columna vertebral cervical (trastorno), fractura de la columna vertebral cervical, fractura del cuello, Fractura de la vertebra cervical |
Japanese | 頚椎骨折, ケイツイコッセツ |
Czech | Zlomená krční páteř, Zlomenina krčního obratle |
Korean | 목의 골절, 상세불명의 목 부분의 골절 |
Hungarian | Nyakcsigolyatörés, Nyakigerinctörés |
Ontology: Fracture of first cervical vertebra (C0349012)
Concepts | Injury or Poisoning (T037) |
ICD10 | S12.0 |
SnomedCT | 207983003 |
English | Fracture/1st cervical vertebra, Atlas, Fracture of first cervical vertebra, fracture of first cervical vertebra (diagnosis), Fracture of first cervical vertebra (disorder), atlas; fracture, fracture; atlas, fracture; spine or vertebra, atlas, fracture; spine or vertebra, cervical, first (atlas), spine or vertebra; fracture, atlas, spine or vertebra; fracture, cervical, first (atlas) |
German | Fraktur des 1. Halswirbels |
Korean | 제1목척추뼈의 골절 |
Dutch | atlas; fractuur, fractuur; atlas, fractuur; wervel{kolom}, atlas, fractuur; wervel{kolom}, cervicaal, eerste (atlas), wervel{kolom}; fractuur, atlas, wervel{kolom}; fractuur, cervicaal, eerste (atlas), Fractuur van eerste cervicale wervel |
Spanish | fractura de la primera vértebra cervical (trastorno), fractura de la primera vértebra cervical |
Ontology: Fracture of second cervical vertebra (C0349013)
Concepts | Injury or Poisoning (T037) |
ICD10 | S12.1 |
SnomedCT | 207984009 |
English | Fracture/2nd cervical vertebra, Axis, Fracture of second cervical vertebra, fracture of second cervical vertebra (diagnosis), Fracture of second cervical vertebra (disorder), axis; fracture, fracture; axis, fracture; spine or vertebra, axis, fracture; spine or vertebra, cervical, second (axis), spine or vertebra; fracture, axis, spine or vertebra; fracture, cervical, second (axis) |
German | Fraktur des 2. Halswirbels |
Korean | 제2목척추뼈의 골절 |
Dutch | axis; fractuur, fractuur; axis, fractuur; wervel{kolom}, cervicaal, tweede (draaier), fractuur; wervel{kolom}, draaier, wervel{kolom}; fractuur, cervicaal, tweede (draaier), wervel{kolom}; fractuur, draaier, Fractuur van tweede cervicale wervel |
Spanish | fractura de la segunda vértebra cervical (trastorno), fractura de la segunda vértebra cervical |
Ontology: Hangman's fracture (C0434858)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 263070009 |
English | Hangman fracture, Hangman's fracture (diagnosis), fracture of pedicle cervicle spine hangman's, Hangman's fracture, Hangman's fracture (disorder) |
Spanish | fractura de Hangman (trastorno), fractura de Hangman |
Ontology: Jefferson fracture (C0435351)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 263180005 |
Dutch | atlasfractuur |
French | Fracture de Jefferson |
German | Jefferson-Fraktur |
Italian | Frattura di Jefferson |
Portuguese | Fractura de Jefferson |
Spanish | Fractura de Jefferson, fractura de Jefferson (trastorno), fractura de Jefferson, fractura del arco del atlas |
Japanese | ジェファーソン骨折, ジェファーソンコッセツ |
Czech | Jeffersonova zlomenina |
English | Jefferson's fracture, fracture jeffersons, jefferson's fracture, fractures jefferson, jefferson fracture, fracture of first cervical vertebra jefferson, fracture of first cervical vertebra jefferson (diagnosis), Jefferson fracture, Fracture arch of atlas, Jefferson fracture (disorder) |
Hungarian | Jefferson-féle törés |
Ontology: Fracture of odontoid process (C0559777)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281910003 |
English | odontoid fracture, Fracture of odontoid peg, Fracture of odontoid process, fracture of odontoid process, dens fracture of second cervical vertebral body (diagnosis), dens fracture of second cervical vertebral body, fracture of second cervical vertebra, odontoid process (diagnosis), fracture of second cervical vertebra, odontoid process, Fracture of odontoid peg (disorder), fracture; odontoid process, process; odontoid, fracture |
Dutch | fractuur; processus odontoideus, processus; odontoideus, fractuur |
Spanish | fractura de apófisis odontoides (trastorno), fractura de apófisis odontoides |
Ontology: Teardrop fracture of cervical vertebra (C0559778)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281911004 |
English | Tear drop fract cervical vert, Tear drop fracture of cervical vertebra, fracture teardrop of cervical vertebra (diagnosis), fracture teardrop of cervical vertebra, Teardrop fracture of cervical vertebra (disorder), Teardrop fracture of cervical vertebra |
Spanish | fractura en lágrima de vértebra cervical, fractura en gota de lágrima de vértebra cervical (trastorno), fractura en gota de lágrima de vértebra cervical, fractura en lágrima de vértebra cervical (trastorno) |
Ontology: Wedge fracture of cervical vertebra (C0559779)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281912006 |
English | Collapse fract cervic vertebra, Wedge fract cervical vertebra, wedge fracture of cervical vertebral body, wedge fracture of cervical vertebral body (diagnosis), Collapse wedge fracture of cervical vertebra, Wedge fracture of cervical vertebra, Wedge fracture of cervical vertebra (disorder) |
Spanish | fractura en cuña de vértebra cervical (trastorno), fractura en cuña de vértebra cervical, fractura en cuña por compresión de vértebra cervical |
Ontology: Burst fracture of cervical vertebra (C0559781)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281914007 |
English | Burst fract cervical vertebra, burst fracture of cervical vertebral body, burst fracture of cervical vertebral body (diagnosis), Burst fracture of cervical vertebra, Burst fracture of cervical vertebra (disorder) |
Spanish | fractura por estallido de vértebra cervical (trastorno), fractura por estallido de vértebra cervical |
Ontology: Fracture of spinous process of cervical vertebra (C0559785)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 281918005 |
English | Fract spin proc cervical vert, fracture of spinous process of cervical vertebra (diagnosis), Fracture of spinous process of cervical vertebra, Fracture of spinous process of cervical vertebra (disorder) |
Spanish | fractura de apófisis espinosa de vértebra cervical (trastorno), fractura de apófisis espinosa de vértebra cervical |
Ontology: Dislocation of cervical facet joint (C1281992)
Concepts | Injury or Poisoning (T037) |
SnomedCT | 314195000 |
English | dislocation cervical vertebra facet joint, Dislocation of cervical facet joint (diagnosis), Dislocation of cervical facet joint (disorder), Dislocation of cervical facet joint |
Spanish | luxación de articulación cigoapofisaria cervical (trastorno), luxación de articulación cigoapofisaria cervical |