Cervical spine injuries Cervical Fractures by Dr. Kalaivanan Kanniyan

1. Cervical Spine Injuries

2. CERVICAL SPINE

3. CERVICAL SPINE
• Seven Cervical Vertebrae
• Eight pairs of Cervical spinal
nerves

4. Cervical Spine Injuries
Main Cause of the disease
TRAUMA

5. RTA – leading cause

6. 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

7. Mode of injury

8. Mechanism of Injury
• NO STUDY TILL DATE WHICH CORELATES
SEVERITY OF INJURY WITH
MODE OF TRAUMA / INJURY

9. Cervical Spine Injuries
Cervical spine injuries
with cord injury
without cord injury

10. Cervical Spine Injuries
• PRESENTING COMPLAINTS
• Pain
• Quadriplegia

11. Myotome and Dermatome Testing
Nerve Root Sensory Testing
Level
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

12. DERMATOME DISTRIBUTION

13. INVESTIGATIONS
• Radiological
• X-rays
AP, Lat , Swimmers view , odontoid view
• CT Scan
• MRI
must for patients with neurological loss

14. DIGNOSTIC – PRE OPERATIVE

15. X-RAYS
Lateral 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

16. DIGNOSTIC – PRE OPERATIVE
CT SCAN
MRI

17. 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

18. LAT VIEW – X RAY

19. LAT VIEW – X RAY
Prevertebral soft tissue
Nasopharyngeal space
Retropharyngeal space
Retrotracheal space

20. AP and Odontoid View

21. Initial Treatment
• CAB
• Immobilization
rigid cervical orthosisPhiladelphia collar
Spine Board
cervical traction with Halo or
Gardner wells tongs.

22. Initial Treatment
NO
YES

23. Treatment - Conservative
Halo traction
Gardner wells tongs

24. Surgical Treatment
• Stabilisation
• Anterior
• Posterior
• Combined/ Global fusion

25. Surgical Treatment

26. Surgical Treatment

27. Surgical Treatment

28. Surgical Treatment

29. 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

30. Occipito-atlantal Dislocation
hyperextension distraction
and rotation of craniovertebral
junction
severe neurological injuries from
complete C1 quadriplegia to
incomplete syndromes

31. Surgical Treatment

32. 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

33. 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.

34. Jefferson Fracture

35. Odontoid Fracture [Axis]
• 15 % all cervical fractures
• usually hyperflexion with anterior displacement
• assoc injuries to C1 common
• neurological deficit in 15-25% cases

36. 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

37. Odontoid Fracture

38. Odontoid Fracture

39. 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)

40. C2 Hangman’s Fracture
Fx through the pars reticularis of C2 secondary to hyperextension

41. Hangman’s C2 Fracture
Traumatic 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

42. Three types of Hangman’s fracture

43. TREATMENT
• Type 1
Conservative - rigid cervical orthosis
• Type 2
– closed reduction with traction
– halo vest immobilization
• Type 3
– Surgical management - C2 -C3 fusion

44. 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

45. Burst Fracture
• Fracture of C3-C7
• axial compression.
• CT is required for all patients
to evaluate extent of injury.

46. Wedge Fracture
• Compression fracture resulting
from flexion.
Buckled anterior cortex.
Loss of height of anterior
vertebral body.
Anterosuperior fracture of
vertebral body.

47. DISLOCATIONS
Bilateral Facet Dislocation
Unilateral Facet Dislocation

48. Cervical spine injuries with Vertebral artery occlusion

49. 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

50. Cervical Spine Injuries
…….. Known is a drop….
…………………..unknown is an
ocean………..
Dr. Kalaivanan Kanniyan
Assistant Professor – Orthopaedics
Arthroplasty and Adult Reconstruction Unit
SMCH, Saveetha University, chennai, Tamil Nadu, India.