cervical spine (C-spine) injury

Etiology

• cervical spine fracture
• intervertebral disc herniation
• dislocation
  • ligament injury

Epidemiology

• most fatal injuries occur at the craniocervical junction or at C1 or C2

Pathology

• flexion injury
• flexion-rotation injury
• extension injury
• extension-rotation injury
• vertical compression injury
• lateral flexion injury
• imprecisely understood mechanisms that may result in
  • odontoid fractures
  • atlanto-occipital dislocation

Clinical manifestations

• pain on movement of neck
• lateral disk herniation
  • pain in ipsilateral shoulder, arm & hand
  • paresthesias
  • weakness depending upon involved nerve roots
  • reflexes may be diminished
  • cough, sneeze & downward compression on the head exacerbate pain
  • traction relieves pain
• central disk protrusion with spinal cord compression
  • generally painless
  • may simulate degenerative disease (i.e. ALS)

Radiology

• see cervical spine fracture

Differential diagnosis

• cauda equina syndrome
• vertebral artery dissection
• hanging injuries & strangulation
• neck trauma
• cervical strain
• spinal cord neoplasm
• septic shock
• spinal cord infection
• thoracic outlet syndrome
• torticollis

Management

• first aid
  • spinal immobilization for patients with major trauma & patients whose mechanism of injury is not clear
  • cervical spine immobilization device
  • logroll technique when transferring the patient onto a long spine board or rescue board
• once in the hospital
  • remove the patient from the board as soon as practical
    • some patients develop decubitus ulcers after 1 hour
• cervical spine clearance
• supportive care
  • ABC & immobilization
  • maintain hemodynamic stability
• high dose glucocorticoids may be of benefit
  • administer within 8 hours of injury
  • methylprednisolone 30 mg/kg bolus, then 5.4 mg/kg/hr after 1 hour for 23 hours
  • conflicting reports, risk of infection
• orthopedic surgery &/or neurosurgery consult
  • goals of surgery
    • decompress the spinal cord canal
    • stabilize the disrupted vertebral column

More general terms

• spine trauma

Additional terms

• cervical myelopathy
• cervical spine (C-spine)
• cervical spine (C-spine) clearance
• cervical spine fracture