A cervical fracture means that a bone is broken in the neck (cervical) region of the spine. A cervical dislocation means that a ligament injury in the neck has occurred, and two (or more) of the adjoining spine bones have become abnormally separated from each other, causing instability. Patients can have a cervical fracture or dislocation, or both. Fractures and dislocations of the cervical spine are not uncommon and account for almost half of all spinal column injuries that occur every year. The majority of fractures and dislocations of the spinal column occur in the cervical spine because it is the most mobile portion of the spinal column, and understandably, the most vulnerable to injury. Although the low back (lumbar) region is most commonly injured during daily laborious, low-energy activities, the neck is most likely to be injured during high-energy trauma such as motor vehicle accidents.
Cervical fractures and dislocations are typically classified according to their region/location and injury/fracture pattern.
How is it diagnosed?
Cervical spine fractures and dislocations should always be suspected when a patient has been involved in a trauma or accident, especially those patients with neck pain. The diagnosis can be complicated when the symptoms or physical findings are atypical. Some patients with other fractures or injuries will complain about pain in other locations, but not complain of neck pain.
At times, patients may downplay the severity of the motor vehicle accident or trauma. These scenarios may sway the clinician away from ordering cervical x-rays and imaging studies, which are crucial in the diagnosis of cervical injuries. It is important for the clinician to conduct a thorough history and clinical examination, especially inspection and palpation of the spine, prior to formulating a diagnosis so as not to misdiagnose this condition. Any patient involved in a severe accident or trauma, especially those patients with neck pain, should be carefully evaluated with x-rays and additional imaging studies, if necessary, to accurately diagnose a cervical injury.
What are the treatment options?
The treatment options for patients with a cervical fracture and/or dislocation are limited and can be categorized as conservative, or nonoperative, and surgical, or operative. Initial treatment of severe cervical fractures and dislocations may involve skeletal traction and closed reduction, with metal pins placed in the skull connected to a pulley, rope and weights. Nonoperative treatments include brace (orthotic) treatment and medications. There are a wide range of cervical orthoses, which ranges from soft collars to hard plastic cervical-thoracic orthoses to halo vest immobilization, which uses pins that are anchored into the skull and stabilized by a padded plastic vest. Surgical treatments frequently involve posterior cervical fusion and instrumentation, which includes inserting small metal screws and rods to stabilize the spine. Other options include anterior decompression and fusion with or without instrumentation. Severely unstable fractures may require anterior and posterior neck surgery. The overall goals of treatment are to preserve or improve neurologic function, provide stability and decrease pain. If these goals can be accomplished with conservative, or nonoperative, means, then that is generally preferred. However, because many cervical fractures and dislocations are highly unstable and will not adequately heal on their own, surgical stabilization is routinely performed. Surgical decompression, which is the removal of bone fragments off of the spinal cord, may also be necessary to maximize a patient’s chances for neurologic improvement and recovery from a spinal cord injury.
Although there are guidelines for the treatment of cervical fractures and dislocations, the specific treatment of a cervical fracture and/or dislocation ultimately depends on a number of factors.
- type and location of fracture
- severity of fracture and amount of displacement
- presence of spinal cord/nerve compression
- presence of neurologic dysfunction or spinal cord injury
- patient’s age, medical condition and associated injuries
The clinician should carefully evaluate a patient’s injuries and individualize treatment with the general management guidelines for cervical fractures in mind, based on all of the above-mentioned factors.