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Cervical fractures

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Upper cervical spine

Jefferson's fracture

  • four part fracture of the ring of the atlas (C1) caused by a fall on the vertex
  • if the combined lateral displacement of the lateral masses exceeds 7 mm, disruption of the transverse ligament has occurred and fracture is quite unstable

Atlantoaxial instability

  • Sagittal: a gap greater than 4 mm due to insufficiency of the transverse ligament. Can be trauma or inflammatory eg Rheumatoid arthritis
  • Rotational: is a subluxation of variable degree, recognised by asymmetry of the gap between the lateral aspect of the odontoid and the lateral mass of C1 on each side and also a decreased joint space between the lateral masses of C1 and C2.
  • Odontoid Fractures: caused by shear forces in the sagittal plane. Classified by Anderson and D’Alonzo into three types.
  • Type I: rare; occurs above the base of the odontoid and is most often stable.
  • Type II: occurs at the base of the odontoid and is usually unstable. Remember in children < 6 years old the epiphysis may be present and may appear as a fracture at this site.
  • Type III: is a fracture of the odontoid that extends into the vertebral body.

Hangman's fracture

  • traumatic spondylolisthesis of C2-C3.
  • bipedicle fracture of C2; usually from an extensive force, with anterior displacement of the body of C2 on C3.
  • low incidence of neurological sequelae but it is unstable

Lower cervical spine (C3-7)

Flexion

  • Compressive: usually fractures vertebral body. Extent of injury varies.
  • Distractive: force begins posteriorly.

Extension

  • Compressive: results in fractures which may be sheared off. Can be unilateral or bilateral. Neurological injury may be less severe than the bony injury.
  • Distractive: Easily missed radiologically and is associated with a low incidence of neurological involvement.

Vertical compression:

  • Axial load causes centrifugal displacement and intrusion into the neural canal and subsequent neurological injury.

Lateral flexion:

  • results in compression and fracturing of the lateral mass, and also frequent collateral ligament disruption.
  • usually associated with nerve root injury on the compressed side.
 

©Charles Gomersall, October, 2009 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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