Definition and Overview

A cervical fracture refers to a broken or fractured neck. It is an orthopaedic condition that occurs when a vertebra in the cervical region of the spine is broken or displaced usually due to high-energy trauma such as motor accidents or high-impact sports-related injuries. The condition is relatively common because the cervical spine is the most mobile portion of the spinal column and is thus the most vulnerable to injury.

The cervical spine is composed of seven vertebrae that are joined together at the back by facet joints. The first two, which are called C1 and C2, are the ones that provide mobility for the skull. C1 is where the skull rests upon and it rotates around C2, allowing the rotation as well as the forward and backward movements of the head and neck. About 50% of cervical spine fractures affect the C6 and C7 vertebrae while about 25% takes place at the level of C2. Most cervical fractures are mild or moderate. However, those that break or displace the C1 and C2 vertebrae are considered the most serious and are potentially fatal.

Any injury to the cervical spine can have serious consequences because the spinal cord connects the body to the brain. In severe cases, the condition leads to permanent paralysis from the neck down or death.

Causes of Condition

A neck fracture is commonly caused by severe trauma that is strong enough to break the cervical vertebrae. Trauma may be caused by:

  • Diving into shallow water

  • Falls

  • Non-contact sports, including gymnastics, surfing, powerlifting, skiing, mountain biking, and motor racing

  • Penetrating neck injuries

  • Severe blow to the neck or head

  • Sports that involve violent physical contact, including wrestling, football, ice hockey, and rugby, among others

  • Sudden twist to the neck

  • Vehicle collisions

  • Work-related injuries

Any abrupt impact or twisting of the neck may break or dislocate a vertebra in the cervical region. This can result in severe and irreversible damage not just to the spinal cord but also other neurologic structures.

Key Symptoms

Cervical fractures can cause different symptoms depending on the extent of damage. These include:

  • Decreased sensation in the arms and legs

  • Limited neck range of motion

  • Localised pain and stiffness

  • Muscle weakness

  • Numbness or weakness of extremities, if there’s neurologic compression or irritation

  • Generalised pain

  • Swelling and bruising

  • Temporary or permanent paralysis from the neck down

  • Loss of bowel or bladder function

  • Absent or diminished deep tendon reflexes

Who to See and Types of Treatments Available

A cervical spine fracture should always be suspected when a person has been involved in an accident or trauma. The condition is diagnosed by clinical examination and radiological studies. These include:

  • X-ray of the cervical spine - An x-ray is a useful imaging test that is often used in orthopaedics for the examination of bony structures including the spine. Using a very small dose of ionising radiation, x-rays can show a cervical fracture and its exact location. The test is deemed safe for both children and adults.

  • Computed tomography (CT) scan - In some cases, nondisplaced or minimally displaced fractures are not detected by plain x-ray. If x-ray results do not show fractures but the patient is showing signs of the condition, a CT scan may be ordered. This test combines computer and x-ray technologies to produce a more detailed image of the body.

  • Flexion/extension x-ray - Used to detect ligamentous instability. Unlike regular x-rays that produce static images, flexion-extension x-ray is taken while the patient is moving the affected vertebra. This is usually advised if a minor cervical fracture is suspected but the x-ray or MRI results are normal or unimpressive.

  • Magnetic resonance imaging (MRI) - This test is useful in evaluating the severity of spinal cord injury or nerve compression. MRI provides high-resolution images of soft tissue and determines if there is damage to the spinal cord.

  • Neurological examinations - Used to assess nerve function or damage.

  • Laboratory tests - Sometimes, laboratory tests are ordered to rule out metabolic conditions or infections that may be causing some of the patient’s symptoms.

All neck injuries are treated as severe or life-threatening until proven otherwise. In the majority of cases, initial treatment is provided by an emergency medical team or trained nurses. They normally immobilise the neck using a soft and rigid neck collar to prevent further displacement or dislocation of the fracture. Immobilisation should remain in place until movement of the neck and head is proven safe.

Treatment depends on the extent and location of damage and may involve non-surgical therapies or invasive surgical procedures.

  • Braces and orthotics - Stable or less serious neck fractures are commonly treated with braces and orthotics, which are designed to maintain spinal alignment. They also immobilise the spine to control pain and allow the fractured vertebrae to heal faster. Most patients have to wear such braces or orthotics up to twelve weeks or until the fracture heals. Doctors also usually prescribe medications to reduce pain and swelling.

  • Cervical fusion - Unstable fractures are treated with surgery with the goal to join two fractured vertebrae using a bone graft taken from the pelvis or bone bank. This graft is held in place by hooks, rods, plates, or pedicle screws. The procedure takes about two hours and requires at least a two-day hospital stay. It requires making an incision either on the back or front of the neck to carry out necessary repairs.

Prior to surgery, patients are informed about the risks and possible complications of the procedure, which include:

  • Adverse reaction to general anaesthesia

  • Formation of blood clots in deep veins

  • Breakage of metal implants

  • Excessive bleeding, which may require a blood transfusion in some cases

  • Failure of fusion

  • Graft rejection

  • Infection

  • Pain in donor site

  • Temporary or permanent nerve or spinal injury

Surgery for the treatment of cervical fracture is immediately followed by physical therapy.

References:

  • Stiell IG, Wells GA, et al. (2001). “The Canadian C-spine rule for radiography in alert and stable trauma patients.”. JAMA. 286 (15): 1841–8. PMID 11597285. doi:10.1001/jama.286.15.1841.

  • Jump up^ Hoffman JR, Wolfson AB, Todd K, Mower WR (1998). “Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS).”. Ann Emerg Med. 32 (4): 461–9. PMID 9774931. doi:10.1016/s0196-0644(98)70176-3.

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