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Cervical Spine Fracture
Aka: Cervical Spine Fracture, C-Spine Fracture, Clay Shoveler's Fracture, Odontoid Process Fracture, Hangman's fracture, Jefferson Fracture, Cervical Wedge Compression Fracture, C1 Fracture, C2 Fracture, Cervical Teardrop Fracture, Cervical Spinous Process Fracture, Cervical Burst Fracture, Cervical Facet Dislocation, Cervical Fracture- See Also
- 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
- 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
- Mechanism
- 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
- Arch Fractures (hyperextension injury)
- 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
- Types: Wedge Compression Fracture
- Mechanism
- Flexion loading of the spine (even minor forces)
- Anterior Vertebral body end plate compression
- Mechanism
- Types: Flexion Teardrop Fracture
- 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
- 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
- Mechanism
- 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)
- Mechanisms
- Imaging
- Management
- See Cervical Spine Injury
- See Cervical Spine Immobilization
- Vertebral Fracture Stability
- References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- Eiff and Hatch (2018) Fracture Management for Primary Care, p. 187-96