Epidemiology

Falls from height Athletic Participation

MVA

Cervical spine injury

Act of violence

Neurologic Injury

Upper Cervical Spine

Lower Cervical Spine

Denis Classification

Mechanism Of Injury
MVA (primarily in young patients), falls (primarily in

older patients), diving accidents, and blunt trauma account for the majority of cervical spine injuries. Most cervical spine injurieForced flexion or extension.

Handbook of Fracture 3rd Edition

Clinical Evaluation
Basic principle in evaluation traumatized

patientassume the presence of possibly unstable spinal injury C-Spine immobilization until determination of spine stability has been made

Brinker

 History of injury (if available)review basic vital

signSuccess rescucitationassesment for spinal injuryinspection and palpation neck and backassess GCS, cranial nerve function, evaluate motor, sensory and reflex function Rectal examination should be performed in patient suspect SCI and unconscious

Brinker

Radiographic evaluation
Radiographic evaluation on C spine suggested in: Patient with neck pain after significance injury Prescence of facial fracture Polytrauma Neurological deficits/symptoms Altered mental status and history of possible trauma

Brinker

Imaging
AP view Open Mouth view

 Lateral view

Apley's System of Orthopaedics & Fractures - 9th Edition

Upper Cervical Landmark

OTA Classfication Of Cervical Spine Injury

INJURIES TO THE OCCIPUT-C1-C2 COMPLEX As with other transitional regions of the spine, the craniocervical junction is highly susceptible to injury. This regions vulnerability to injury is particularly

Handbook of Fracture 3rd Edition

Occipital Condyle Fractures

These are frequently associated with C1 fractures as

well as cranial nerve palsies. The mechanism of injury involves compression and lateral bending CT is frequently necessary for diagnosis.

Handbook of Fracture 3rd Edition

Anderson and Montesano classification of occipital condyle fractures

(A) Type I injuries are comminuted, usually stable, impaction fractures caused by axial loading. (B) Type II injuries are impaction or shear fractures extending into the base of the skull, and are usually stable. (C) Type III injuries are alar ligament avulsion fractures and are likely to be unstable distraction injuries of the craniocervical junction.

Cont
Type I: Impaction of condyle; usually stable Type II: Shear injury associated with basilar or skull

fractures; potentially unstable Type III: Condylar avulsion; unstable Treatment includes rigid cervical collar immobilization for 8 weeks for stable injuries and halo immobilization or occipital-cervical fusion for unstable injuries.
Handbook of Fracture 3rd Edition

Occipitoatlantal Dislocation
Classification based on the position of the occiput in relation to

C1 is as follows:

Type I: Occipital condyles anterior to the atlas; most common Type II: Condyles longitudinally dissociated from atlas without

translation; result of pure distraction Type III: Occipital condyles posterior to the atlas

The Harborview classification attempts to quantify stability of

Type I: Stable with displacement <2 mm Type II: Unstable with displacement <2 mm Type III: Gross instability with displacement >2 mm
Handbook of Fracture 3rd Edition

craniocervical junction. Surgical stabilization is reserved for type II and III injuries.

 Immediate treatment includes halo vest application

with strict avoidance of traction. Reduction maneuvers are controversial and should ideally be undertaken with fluoroscopic visualization. Long-term stabilization involves fusion between the occiput and the upper cervical spine.
Handbook of Fracture 3rd Edition

Atlas Fractures
Classification (Levine) Isolated bony apophysis fracture Isolated posterior arch fracture Isolated anterior arch fracture Comminuted lateral mass fracture Burst fracture

Handbook of Fracture 3rd Edition

 Initial treatment includes halo traction/immobilization. Stable fractures may be treated with a rigid cervical

orthosis. Less stable configurations may require prolonged halo immobilization. C1-C2 fusion may be necessary to alleviate chronic instability and/or pain.
Handbook of Fracture 3rd Edition

Odontoid fractures
Classification (Anderson and DAlonzo) Type I An avulsion fracture of the tip of the odontoid process due to traction by the alar ligaments. The fracture is stable (above the transverse ligament) and unites without difficulty. Type II A fracture at the junction of the odontoid process and the body of the axis. This is the most common (and potentially the most dangerous) type. The fracture is unstable and prone to non-union. Type III A fracture through the body of the axis. The fracture is stable and almost always unites with immobilization.

 Patients often present with neck pain, limited range of

motion, and no neurologic injury. The mechanisms of injury are axial compression and lateral bending. CT is helpful for diagnosis. A depression fracture of the C2 articular surface is common. Treatment ranges from collar immobilization to late fusion for chronic pain.