cervical fractures and cervical spine injuries - dr.kk

Cervical Spine Injuries

CERVICAL SPINE

CERVICAL SPINE

• Seven Cervical Vertebrae

• Eight pairs of Cervical spinal nerves

Cervical Spine Injuries

Main Cause of the disease

TRAUMA

RTA – leading cause

Mode of injury

• Road side accidents (RSA)

• Fall from height

• Accidental injury due to carrying heavy

weight over head

• Sports injuries

• Trivial Trauma in Pre-existing Spondylotic

spine

Mode of injury

Mechanism of Injury

• NO STUDY TILL DATE WHICH CORELATES

SEVERITY OF INJURY WITH

MODE OF TRAUMA / INJURY

Cervical Spine Injuries

Cervical spine injuries

with cord injury

without cord injury

Cervical Spine Injuries

• PRESENTING COMPLAINTS

• Pain

• Quadriplegia

Myotome and Dermatome Testing

Nerve Root Level

Sensory Testing Motor Testing Reflex Testing

C1-C2 Front of face Neck flexion N/A

C3 Lateral face and skull Lateral flexion N/a

C4 Supraclavicular Shoulder shrug N/A

C5 Lateral shoulder/upper arm Shoulder abduction Bicipital (musculocutaneous)

C6 Lateral lower arm and hand (thumb and index finger)

Elbow flexion and wrist extension

Brachialradial (musculocutaneous)

C7 Palmar aspect of hand – middle 3 fingers

Elbow extension and wrist flexion

Triceps (radial)

C8 Medial lower arm and hand Finger flexion and thumb extension

N/A

T1 Medial elbow and upper arm Finger abduction N/A

DERMATOME DISTRIBUTION

INVESTIGATIONS

• Radiological• X-rays AP, Lat , Swimmers view ,

odontoid view

• CT Scan

• MRI must for patients with neurological loss

DIGNOSTIC – PRE OPERATIVE

X-RAYSLateral view

• Top of T1 visible in idle lat view • Three smooth arcs maintained• Vertebral bodies of uniform height• Odontoid intact and closely applied to C1

AP view• Spinous processes straight and spaced equally• Intervertebral spaces roughly equal

Odontoid view• Odontoid intact• Equal spaces on either side of odontoid• Lateral margins of C1 and C2 align

DIGNOSTIC – PRE OPERATIVE

CT SCAN MRI

SIGNS OF INSTABILITY

• AP translation > 3.5mm• spinous process widening on lateral• rotation of facets on lateral

• facet joint widening• malalignment of spinous process on

AP view• lateral tilting of vertebral body on AP

view

LAT VIEW – X RAY

LAT VIEW – X RAY

Prevertebral soft tissue

Nasopharyngeal spaceRetropharyngeal space Retrotracheal space

AP and Odontoid View

Initial Treatment• CAB • Immobilization rigid cervical

orthosis- Philadelphia collar

Spine Board

cervical traction with Halo or Gardner wells tongs.

Initial Treatment

NO

YES

Treatment - Conservative

Halo traction Gardner wells tongs

Surgical Treatment

• Stabilisation

• Anterior• Posterior• Combined/ Global

fusion

Surgical Treatment

Surgical Treatment

Surgical Treatment

Surgical Treatment

Ferguson and Allen Classification

• Classification is Based on position of neck at time of injury and dominant force

• Compression and Flexion• Vertical Compression• Distraction Flexion• Compression Extension• Compression Distraction• Lateral Flexion

Occipito-atlantal Dislocation

hyperextension distraction

and rotation of craniovertebral junction

severe neurological injuries from complete C1 quadriplegia to incomplete syndromes

Surgical Treatment

ATLAS FRACTURE

• Axial compression injuries• neurological injury rare• 3 types

Jefferson fracture- direct compression and lateral masses forced apart

asymmetric load fracture ant or post to mass and displaces it

posterior arch fractures with an extension moment through it

Jefferson Fracture

• Compression fracture of the bony ring of C1

• Odontoid view

• Displacement of the lateral masses of vertebrae C1 beyond the margins of the body of vertebra C2.

Jefferson Fracture

Odontoid Fracture [Axis]

• 15 % all cervical fractures

• usually hyperflexion with anterior displacement

• assoc injuries to C1 common• neurological deficit in 15-25% cases

Odontoid Fracture

• Best seen on the lateral view

• Types– I – Fx through superior portion of dens– II – Fx through the base of the dens– III – Fx that extends into the body of C2

Odontoid Fracture

Odontoid Fracture

Odontoid Fracture

Type 1 - Philadelphia collar for 6-8 weeks

Type 2 undisplaced - halo immobilization displaced - Primary C1-C2 fusion after

reduction in traction [most recommend if displacement > 4-5mm]

Type 3 Halo vest immobilization after reduction in

traction ( 3-4 months)

C2 Hangman’s FractureFx through the pars reticularis of C2 secondary to

hyperextension

Hangman’s C2 FractureTraumatic spondylolithesis

• Type 1 isolated minimally displaced fracture of ring with no

angulation

• Type 2 more unstable flesion type/extension type or listhetic type displaced > 3mm and angulation of C2-C3 disk space ALL, PLL Disc can be interrupted

• Type 3 rare , anterior dislocation of C2 facets on C3 with 2

extension fracturing neural arch

Three types of Hangman’s fracture

TREATMENT

• Type 1Conservative - rigid cervical orthosis

• Type 2– closed reduction with traction– halo vest immobilization

• Type 3– Surgical management - C2 -C3 fusion

Clay Shoveler’s Fracture

• Fracture of a spinous process C6-T1

• Signs: – Spinous process

fracture on lateral view.

– Ghost sign on AP view

(i.e. double spinous process of C6 or C7 resulting from displaced fractured spinous

Burst Fracture

• Fracture of C3-C7 • axial compression.

• CT is required for all patients to evaluate extent of injury.

Wedge Fracture

• Compression fracture resulting from flexion.

Buckled anterior cortex.

Loss of height of anterior vertebral body.

Anterosuperior fracture of vertebral body.

DISLOCATIONS

Bilateral Facet Dislocation Unilateral Facet Dislocation

Cervical spine injuries with Vertebral artery occlusion

Prevention is Better than Cure

When meditating over a disease, I

never think of finding a remedy for it,

but instead, a means of preventing it ”

Louis Pasteur

Thanks

Cervical Spine Injuries

…….. Known is a drop….…………………..unknown is an ocean………..

Dr. Kalaivanan Kanniyan Assistant Professor – OrthopaedicsArthroplasty and Adult Reconstruction UnitSMCH, Saveetha University, chennai, Tamil

Nadu, India.