Fractures of the cervical spine

Abstract

Objectives: The aim of this study was to review the literature on cervical spine fractures.

Methods: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed.

Results: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures.

Conclusions: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative.

Figure 1

AO classification. A compression: A.1  =  impaction; A.2  =  split; A.3  =  burst.

Figure 2

AO classification. B distraction: B.1  =  posterior distraction with vertebral body intact; B.2  =  posterior distraction + fracture of the vertebral body; B.3  =  anterior distraction + hyperextension.

Figure 3

AO classification. C rotation: C.1  =  unilateral facet fracture-dislocation; C.2  =  unilateral facet dislocation; C.3  =  rotational shear injury of the joint mass.