cervical spine fracture

Etiology

• trauma
  • motor vehicle accidents

Epidemiology

• 1/3 occur at C2
• 1/2 occur at C6 or C7
• most fatal injuries occur at the craniocervical junction or at C1 or C2

Radiology

• computed tomography
  • recommended for routine screening of cervical spine injury
  • very sensitive
  • can identify even subtle fractures
• magnetic resonance imaging
  • modality of choice to detect spinal cord injury
  • sensitive for detecting lesions of both neural tissue & bone

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

• vertebral fracture; spine fracture

Additional terms

• cervical spine (C-spine)
• cervical spine (C-spine) clearance
• cervical spine (C-spine) injury